Provider Demographics
NPI:1003680034
Name:TOMIC, JASMINE RUBY (COTA/L)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:RUBY
Last Name:TOMIC
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-5075
Mailing Address - Country:US
Mailing Address - Phone:330-812-5413
Mailing Address - Fax:
Practice Address - Street 1:3600 HERBERT ST
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-1125
Practice Address - Country:US
Practice Address - Phone:330-628-9947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA008522224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant