Provider Demographics
NPI:1407124159
Name:JORDAN, LISA ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17641 WOOLWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4617
Mailing Address - Country:US
Mailing Address - Phone:402-391-0804
Mailing Address - Fax:
Practice Address - Street 1:16910 FRANCES ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2399
Practice Address - Country:US
Practice Address - Phone:402-932-3355
Practice Address - Fax:402-932-3370
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE619225XF0002X
NE1292225XF0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing