Basic Information
Provider Information
NPI: 1790071850
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JANSEN
FirstName: CATHERINE
MiddleName: JOAN
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 985450 NEBRASKA MEDICAL CTR
Address2:  
City: OMAHA
State: NE
PostalCode: 681985450
CountryCode: US
TelephoneNumber: 4025596580
FaxNumber: 4025595737
Practice Location
Address1: 444 S 44TH ST
Address2:  
City: OMAHA
State: NE
PostalCode: 681313727
CountryCode: US
TelephoneNumber: 4025596580
FaxNumber: 4025595737
Other Information
ProviderEnumerationDate: 06/27/2011
LastUpdateDate: 05/21/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X1435NEY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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