Healthcare Provider Details

I. General information

NPI: 1861604845
Provider Name (Legal Business Name): JAN HARRIS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2 BOX A
MILFORD NE
68405
US

IV. Provider business mailing address

6501 PARK CREST DRIVE
LINCOLN NE
68506
US

V. Phone/Fax

Practice location:
  • Phone: 402-761-3230
  • Fax:
Mailing address:
  • Phone: 402-783-2786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1036
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: