MEDICARE: AMBER JENSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	001870	IA

General Provider Information

NPI Number	:	1326413774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER JENSEN

Provider Business Mailing Address
First Line	:	7413 CORRECTIONVILLE RD
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-9655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7413 CORRECTIONVILLE RD
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-9655
Country	:	US
Telephone Number	:	712-253-0842
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	12/10/2015

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Directions to “ AMBER JENSEN ” Practice Location

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