Provider Demographics
NPI:1972712156
Name:JENSEN, DONNA MAE DOEGE (OTR)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MAE DOEGE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MAE
Other - Last Name:BLACKSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3510 GUNSTON LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-4918
Mailing Address - Country:US
Mailing Address - Phone:651-738-6054
Mailing Address - Fax:651-254-0910
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-1697
Practice Address - Fax:651-254-0910
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101429225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist