Individual
MIKE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5217 S 28TH ST, OMAHA, NE 68107-3402
(402) 715-5440
Mailing address
2502 GEORGIA AVE, BELLEVUE, NE 68147-2426
(402) 397-9866
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
225XM0800X
Mental Health Occupational Therapist
Primary
12342
NE
Other
Enumeration date
03/13/2014
Last updated
09/09/2020
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