Provider Demographics
NPI:1326243569
Name:WENTWORTH, JAYME LYNN (OTD OTRL)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:LYNN
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:OTD OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16422 YATES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2509
Mailing Address - Country:US
Mailing Address - Phone:402-445-2009
Mailing Address - Fax:
Practice Address - Street 1:7350 GRACELAND DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4328
Practice Address - Country:US
Practice Address - Phone:402-572-5750
Practice Address - Fax:402-573-1488
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1011225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist