Healthcare Provider Details

I. General information

NPI: 1346144938
Provider Name (Legal Business Name): JENSEN CLARK OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 MYRTLE AVE
RIDGEWOOD NY
11385-3550
US

IV. Provider business mailing address

102 MADISON AVE FL 8
NEW YORK NY
10016-7584
US

V. Phone/Fax

Practice location:
  • Phone: 347-408-2387
  • Fax: 212-904-0839
Mailing address:
  • Phone: 212-759-2282
  • Fax: 212-379-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number031495
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: