Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1251 | NE |
NPI | 1003114489 |
---|---|
Provider Name | Jessica Ann Berens |
First Address | Omaha, NE 68118-6022 |
Second Address | Omaha, NE 68118-6022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2011 |
Last Update Date | 08/03/2011 |