Provider Demographics
NPI:1780245332
Name:DOIRON, JENSEN
Entity type:Individual
Prefix:
First Name:JENSEN
Middle Name:
Last Name:DOIRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HUTCHINSON ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-2206
Mailing Address - Country:US
Mailing Address - Phone:207-608-3144
Mailing Address - Fax:
Practice Address - Street 1:17 HUTCHINSON ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-2206
Practice Address - Country:US
Practice Address - Phone:207-608-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0720134047225X00000X
CT5082225X00000X
MA12973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist