Individual
KARISSA GAYLE JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
12997 NETTLES DR, NEWPORT NEWS, VA 23602-6913
(757) 249-8880
Mailing address
4356 DUFFY DR, VIRGINIA BEACH, VA 23462-7951
(954) 557-6739
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
0131001672
VA
224Z00000X
Occupational Therapy Assistant
Primary
9353
NC
Other
Enumeration date
01/03/2017
Last updated
01/03/2017
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