Healthcare Provider Details

I. General information

NPI: 1083076806
Provider Name (Legal Business Name): JENARAE VIETH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENARAE HAND OTR/L

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 W FAIDLEY AVE
GRAND ISLAND NE
68803-4109
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 308-398-5170
  • Fax: 308-398-5175
Mailing address:
  • Phone: 308-382-0344
  • Fax: 308-382-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1958
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: