Provider Demographics
NPI:1417569476
Name:JENSEN, REBECCA MAE (OTD, OTR/L, ATC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MAE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:OTD, OTR/L, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 ORCHARD ST W APT 94
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-3804
Mailing Address - Country:US
Mailing Address - Phone:515-422-6766
Mailing Address - Fax:
Practice Address - Street 1:801 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:EAGLE GROVE
Practice Address - State:IA
Practice Address - Zip Code:50533-2478
Practice Address - Country:US
Practice Address - Phone:515-448-4599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7206225X00000X
IA128889225X00000X
WA61090602225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist