Individual
KOKOU GMADJOME TAKASSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14302 VIRGINIA ST, OMAHA, NE 68138-3563
(402) 808-6031
Mailing address
14302 VIRGINIA ST, OMAHA, NE 68138-3563
(402) 808-6031
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
02/12/2025
Last updated
02/12/2025
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