Individual
JORDYN ELIZABETH PENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3119 W FAIDLEY AVE, GRAND ISLAND, NE 68803-4114
(308) 384-2333
Mailing address
230 E C ST, HASTINGS, NE 68901-6380
(308) 850-2436
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1016
NE
Other
Enumeration date
08/14/2017
Last updated
08/14/2017
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