Active NPI
Jordyn Elizabeth Penner, COTA/L
- Occupational Therapy Assistant
- Grand Island, NE
National Provider Identifier
1407372287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 1016
- Practice address
- 3119 W Faidley Ave
Grand Island, NE 68803-4114 - Phone
- (308) 384-2333
- NPI assigned
- Aug 14, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 1016 | NE | Primary |
Addresses
Primary practice location
3119 W Faidley Ave
Grand Island, NE 68803-4114
Mailing address
230 E C St
Hastings, NE 68901-6380
Phone (308) 850-2436
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1016 | NE | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502668800000",
"number": "1407372287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 E C ST",
"city": "HASTINGS",
"state": "NE",
"postal_code": "689016380",
"telephone_number": "308-850-2436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3119 W FAIDLEY AVE",
"city": "GRAND ISLAND",
"state": "NE",
"postal_code": "688034114",
"telephone_number": "308-384-2333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNER",
"first_name": "JORDYN",
"middle_name": "ELIZABETH",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-14",
"last_updated": "2017-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NE",
"license": "1016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Island, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.