Provider Demographics
NPI:1003398090
Name:BENSON, JACKIE LYNNE (MOT, OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:LYNNE
Last Name:BENSON
Suffix:
Gender:F
Credentials:MOT, OTR/L, CLT
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:LYNNE
Other - Last Name:STRAUBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61740 US HIGHWAY 136
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:NE
Mailing Address - Zip Code:68450-8401
Mailing Address - Country:US
Mailing Address - Phone:402-335-7964
Mailing Address - Fax:
Practice Address - Street 1:1043 10TH ST
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:NE
Practice Address - Zip Code:68376-6018
Practice Address - Country:US
Practice Address - Phone:402-862-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2247225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2247OtherDHHS