Provider Demographics
NPI:1780266130
Name:JENSEN, KATHRYN (OMT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5154 59TH WAY N
Mailing Address - Street 2:
Mailing Address - City:KENNETH CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33709-3548
Mailing Address - Country:US
Mailing Address - Phone:727-631-2645
Mailing Address - Fax:
Practice Address - Street 1:5154 59TH WAY N
Practice Address - Street 2:
Practice Address - City:KENNETH CITY
Practice Address - State:FL
Practice Address - Zip Code:33709-3548
Practice Address - Country:US
Practice Address - Phone:727-631-2645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist