Provider Demographics
NPI:1700133428
Name:FANNING, JENNIFER SUE (MS OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:FANNING
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:KUPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:85414 553RD AVE
Mailing Address - Street 2:
Mailing Address - City:PIERCE
Mailing Address - State:NE
Mailing Address - Zip Code:68767
Mailing Address - Country:US
Mailing Address - Phone:308-325-6536
Mailing Address - Fax:308-995-6587
Practice Address - Street 1:1500 KOENIGSTEIN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701
Practice Address - Country:US
Practice Address - Phone:402-644-7396
Practice Address - Fax:402-644-7394
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE741225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics