Individual
BRENT ALLEN ENNINGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTD, OTR/L
Contact information
Practice address
1340 ELBA AVE, LINCOLN, NE 68521-2044
(402) 261-3272
Mailing address
1340 ELBA AVE, LINCOLN, NE 68521-2044
(402) 261-3272
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1037
NE
Other
Enumeration date
06/23/2009
Last updated
06/23/2009
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