Provider Demographics
NPI:1023372406
Name:JENSEN, AMANDA (OTR)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 S COLLEGE AVE
Mailing Address - Street 2:STE. 108
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4196
Mailing Address - Country:US
Mailing Address - Phone:970-407-9999
Mailing Address - Fax:
Practice Address - Street 1:3307 S COLLEGE AVE
Practice Address - Street 2:STE. 108
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4196
Practice Address - Country:US
Practice Address - Phone:970-407-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3265225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist