Provider Demographics
NPI:1558560235
Name:STREETER, JENNIFER L A (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L A
Last Name:STREETER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4000 SOUTH 56
Mailing Address - Street 2:LAKE PARK CONDOMINIUMS CONDO #260C
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506
Mailing Address - Country:US
Mailing Address - Phone:402-202-2589
Mailing Address - Fax:402-488-2768
Practice Address - Street 1:610 224TH ROAD
Practice Address - Street 2:SUNRISE COUNTRY MANOR
Practice Address - City:MILFORD
Practice Address - State:NE
Practice Address - Zip Code:68405
Practice Address - Country:US
Practice Address - Phone:402-761-3230
Practice Address - Fax:402-761-3133
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE726225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist