Provider Demographics
NPI:1417179615
Name:SYLVAN, JENNIFER ANDREA (MOTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANDREA
Last Name:SYLVAN
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANDREA
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:5032 S 190TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3555
Mailing Address - Country:US
Mailing Address - Phone:402-651-7646
Mailing Address - Fax:
Practice Address - Street 1:5032 S 190TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3555
Practice Address - Country:US
Practice Address - Phone:402-651-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103413225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN670000469Medicare ID - Type Unspecified