Provider Demographics
NPI:1235783895
Name:JENSEN, BROOKE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3889 W STETSON AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-9686
Mailing Address - Country:US
Mailing Address - Phone:951-791-9140
Mailing Address - Fax:
Practice Address - Street 1:3889 W STETSON AVE STE 150
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-9686
Practice Address - Country:US
Practice Address - Phone:951-791-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist