Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 7813666-4201 | UT |
NPI | 1003298225 |
---|---|
Provider Name | Jason Paul Jensen |
First Address | Jacksonville, FL 32214-5005 |
Second Address | Jacksonville, FL 32214-5005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2015 |
Last Update Date | 24/06/2015 |