Healthcare Provider Details

I. General information

NPI: 1558560235
Provider Name (Legal Business Name): JENNIFER L A STREETER OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 224TH ROAD SUNRISE COUNTRY MANOR
MILFORD NE
68405
US

IV. Provider business mailing address

4000 SOUTH 56 LAKE PARK CONDOMINIUMS CONDO #260C
LINCOLN NE
68506
US

V. Phone/Fax

Practice location:
  • Phone: 402-761-3230
  • Fax: 402-761-3133
Mailing address:
  • Phone: 402-202-2589
  • Fax: 402-488-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number726
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: