MEDICARE: JESSICA ANN BERENS OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1251	NE

General Provider Information

NPI Number	:	1003114489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANN BERENS OTR/L

Provider Business Mailing Address
First Line	:	1745 N 175TH CT
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-6022
Country	:	US
Telephone Number	:	402-616-3569
Fax Number	:

Provider Business Practice Location Address
First Line	:	1745 N 175TH CT
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-6022
Country	:	US
Telephone Number	:	402-616-3569
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2011
Last Update Date	:	03/08/2011

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Directions to “ JESSICA ANN BERENS OTR/L” Practice Location

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