Provider Demographics
NPI:1336179670
Name:JENSEN, DONNA S (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:S
Last Name:JENSEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 GREENLEAF CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4411
Mailing Address - Country:US
Mailing Address - Phone:321-637-0879
Mailing Address - Fax:321-637-0879
Practice Address - Street 1:1034 GREENLEAF CT
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4411
Practice Address - Country:US
Practice Address - Phone:321-637-0879
Practice Address - Fax:321-637-0879
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10425225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist