MEDICARE: JENNIFER L LUND OT

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	01748	IA
2	225X00000X	Occupational Therapist	0717	SD

General Provider Information

NPI Number	:	1467488080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L LUND OT

Provider Business Mailing Address
First Line	:	3410 FUTURES DR
Second Line	:
City	:	SOUTH SIOUX CITY
State	:	NE
Zip	:	68776-3917
Country	:	US
Telephone Number	:	402-412-4271
Fax Number	:	402-412-1296

Provider Business Practice Location Address
First Line	:	1204 N SIX MILE RD
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-7401
Country	:	US
Telephone Number	:	605-212-6790
Fax Number	:

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

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	01/02/2018

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