Shannon Renae Ruzicka, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

1246 Issued in NE

Practice address

50 Tall Grass Cir
Bennet, NE 68317-2411

Phone

(402) 310-9505

NPI assigned

Apr 18, 2008

Last updated

Jan 9, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Agewise Therapy LLC

  • Occupational Therapist
  • Bennet, NE
  • NPI 1205726890
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736380800000",
    "number": "1871767988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 TALL GRASS CIR",
            "city": "BENNET",
            "state": "NE",
            "postal_code": "683172411",
            "telephone_number": "402-310-9505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 TALL GRASS CIR",
            "city": "BENNET",
            "state": "NE",
            "postal_code": "683172411",
            "telephone_number": "402-310-9505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUZICKA",
        "first_name": "SHANNON",
        "middle_name": "RENAE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-18",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NE",
            "license": "1246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Bennet, NE
• Providers in Bennet, NE by specialty
• Occupational Therapist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.