Provider Demographics
NPI:1730213588
Name:JENSEN, PER K (OT)
Entity type:Individual
Prefix:
First Name:PER
Middle Name:K
Last Name:JENSEN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 BLUECOAT LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2206
Mailing Address - Country:US
Mailing Address - Phone:410-772-8730
Mailing Address - Fax:
Practice Address - Street 1:ONE TEXAS STATION COURT
Practice Address - Street 2:SUITE 300
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-683-2110
Practice Address - Fax:410-683-2115
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03449225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist