Provider Demographics
NPI:1942891387
Name:JENSEN, ANDREA DAWN (COTA)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:DAWN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 MALMAISON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-5640
Mailing Address - Country:US
Mailing Address - Phone:615-406-7194
Mailing Address - Fax:
Practice Address - Street 1:1234 MALMAISON RIDGE DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-5640
Practice Address - Country:US
Practice Address - Phone:615-406-7194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216639224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant