Provider Demographics
NPI:1437261740
Name:SAUER, JENNIFER K (MA, OTR)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:SAUER
Suffix:
Gender:F
Credentials:MA, OTR
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HOLLIDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:25117 SW PARKWAY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9697
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12705 SE RIVER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222-9799
Practice Address - Country:US
Practice Address - Phone:503-652-6674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI469225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000253567OtherTRICARE
HI56906401Medicaid
HI99-0332020OtherUNIVERSITY HEALTH ALLIANC
HI204196700OtherOWCP
HI56906400OtherALOHA CARE
HI0000253567OtherHMSA - ALL
HI530748OtherHMA
HI99-0332020OtherUNIVERSITY HEALTH ALLIANC