Provider Demographics
NPI:1417208497
Name:EHLERS, JORDAN LEIGH (OTR/L)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEIGH
Last Name:EHLERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LEIGH
Other - Last Name:SCHMOLDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 9TH ST
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-1914
Mailing Address - Country:US
Mailing Address - Phone:402-762-5261
Mailing Address - Fax:
Practice Address - Street 1:318 W 18TH ST
Practice Address - Street 2:
Practice Address - City:COZAD
Practice Address - State:NE
Practice Address - Zip Code:69130-1110
Practice Address - Country:US
Practice Address - Phone:308-784-3715
Practice Address - Fax:308-784-3746
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE901030225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist