Provider Demographics
NPI:1205376241
Name:JENSEN, CHELSIE (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:CHELSIE
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:CHELSIE
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR/L
Mailing Address - Street 1:6703 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-7331
Mailing Address - Country:US
Mailing Address - Phone:435-630-9157
Mailing Address - Fax:
Practice Address - Street 1:4560 SE INTERNATIONAL WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-4628
Practice Address - Country:US
Practice Address - Phone:435-630-9157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR287710225X00000X
UT8094263-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8094263-4201OtherUTAH STATE PRACTICE LICENSE
OR287710OtherOREGON STATE PRACTICE LICENSE