Provider Demographics
NPI:1114579869
Name:JENSEN, BRIAN DAVID (OTD,OTR/L)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DAVID
Last Name:JENSEN
Suffix:
Gender:M
Credentials:OTD,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1992 W ANTELOPE DR STE 1D
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4974
Mailing Address - Country:US
Mailing Address - Phone:801-773-2633
Mailing Address - Fax:
Practice Address - Street 1:1992 W ANTELOPE DR STE 1D
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4974
Practice Address - Country:US
Practice Address - Phone:801-773-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11355367-4201225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand