Provider Demographics
NPI:1932451325
Name:JENSEN, AMY JO (OTR)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JO
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 1:2411 W 110TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3926
Mailing Address - Country:US
Mailing Address - Phone:612-709-3979
Mailing Address - Fax:
Practice Address - Street 1:2411 W 110TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3926
Practice Address - Country:US
Practice Address - Phone:612-709-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104240225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN104240OtherOCCUPATIONAL THERAPY PRACTITIONER
296222OtherNBCOT BOARD CERTIFICATION