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NPI Code Detail

MEDICARE: BRENT ALLEN ENNINGA OTD, OTR/L

MEDICARE: BRENT ALLEN ENNINGA OTD, 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
1225X00000XOccupational Therapist1037NE

General Provider Information

NPI Number : 1982832481
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENT ALLEN ENNINGA OTD, OTR/L
Provider Business Mailing Address
First Line : 1340 ELBA AVE
Second Line :
City : LINCOLN
State : NE
Zip : 68521-2044
Country : US
Telephone Number : 402-261-3272
Fax Number :
Provider Business Practice Location Address
First Line : 1340 ELBA AVE
Second Line :
City : LINCOLN
State : NE
Zip : 68521-2044
Country : US
Telephone Number : 402-261-3272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2009
Last Update Date : 06/23/2009

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Directions to “ BRENT ALLEN ENNINGA OTD, OTR/L” Practice Location

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