Provider Demographics
NPI:1154757862
Name:JENSEN, PEGGY ANN (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4512 128TH PL NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8731
Mailing Address - Country:US
Mailing Address - Phone:360-658-8978
Mailing Address - Fax:
Practice Address - Street 1:4220 80TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3423
Practice Address - Country:US
Practice Address - Phone:360-653-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000285225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist