Provider Demographics
NPI:1134277437
Name:JENSEN, REBECCA NICOLL (OTR CHT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:NICOLL
Last Name:JENSEN
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 ROWLAND WAY
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5042
Mailing Address - Country:US
Mailing Address - Phone:415-898-1311
Mailing Address - Fax:415-897-0741
Practice Address - Street 1:88 ROWLAND WAY
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5042
Practice Address - Country:US
Practice Address - Phone:415-898-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23602225XH1200X
CA2673332BC3200X, 225X00000X
CO0003370225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6035290001Medicare NSC
CA6035290002Medicare NSC
CAZZZ05089ZMedicare PIN