Provider Demographics
NPI:1710634555
Name:JENSSEN, MARIA LAURA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIA LAURA
Middle Name:
Last Name:JENSSEN
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 1:4830 MARINERS WAY APT G
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-6912
Mailing Address - Country:US
Mailing Address - Phone:954-479-1339
Mailing Address - Fax:
Practice Address - Street 1:4830 MARINERS WAY APT G
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-6912
Practice Address - Country:US
Practice Address - Phone:954-479-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT22880225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist