Provider Demographics
NPI:1669771291
Name:JENSEN, BETH ANN (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 N. PERRY STREET
Mailing Address - Street 2:STE 100
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875
Mailing Address - Country:US
Mailing Address - Phone:419-523-9003
Mailing Address - Fax:419-523-9143
Practice Address - Street 1:1880 N. PERRY STREET
Practice Address - Street 2:STE 100
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875
Practice Address - Country:US
Practice Address - Phone:419-523-9003
Practice Address - Fax:419-523-9143
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007620225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2251343Medicaid
OH366639Medicare UPIN