Provider Demographics
NPI:1003386996
Name:JASSIM, NERGIS
Entity Type:Individual
Prefix:
First Name:NERGIS
Middle Name:
Last Name:JASSIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14625 TELEGRAPH RD STE C
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4637
Mailing Address - Country:US
Mailing Address - Phone:734-287-8009
Mailing Address - Fax:
Practice Address - Street 1:14625 TELEGRAPH RD STE C
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4637
Practice Address - Country:US
Practice Address - Phone:734-287-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
MI5302020392225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist