Provider Demographics
NPI:1467488080
Name:LUND, JENNIFER L (OT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:LUND
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 FUTURES DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3917
Mailing Address - Country:US
Mailing Address - Phone:402-412-4271
Mailing Address - Fax:402-412-1296
Practice Address - Street 1:1204 N SIX MILE RD
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-7401
Practice Address - Country:US
Practice Address - Phone:605-212-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01748225X00000X
SD0717225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist