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General NPI Number Information
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NPI Number | 1629554100
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Entity Type | Individual
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Provider Name | RAELYNN JENSEN MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 5901 OURAY RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1381
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Country | US
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Telephone | 505-836-0023
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Fax |
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Provider Business Mailing Address
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Address Line | 50 N MEDICAL DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-0001
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Country | US
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Telephone | 801-581-2121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT.0007012
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 403238
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 10884539-4201
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT4538
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License Number State | NM
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