Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2247 | NE |
NPI | 1003398090 |
---|---|
Provider Name | Jackie Lynne Benson |
First Address | Tecumseh, NE 68450-8401 |
Second Address | Humboldt, NE 68376-6018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2018 |
Last Update Date | 22/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2247 | DHHS (01) | NE |