Provider Demographics
NPI:1770933566
Name:JENSEN, JILL SUZANNE (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:JILL
Middle Name:SUZANNE
Last Name:JENSEN
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 1:4170 SPINNAKER DR
Mailing Address - Street 2:APT 506
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-2957
Mailing Address - Country:US
Mailing Address - Phone:417-619-6105
Mailing Address - Fax:
Practice Address - Street 1:4170 SPINNAKER DR
Practice Address - Street 2:APT 506
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-2957
Practice Address - Country:US
Practice Address - Phone:417-619-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALOT4017225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist