Provider Demographics
NPI:1043804065
Name:ERVES, JASMINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:ERVES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 LAWRENCEVILLE HWY STE B
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3168
Mailing Address - Country:US
Mailing Address - Phone:404-289-4270
Mailing Address - Fax:404-289-4428
Practice Address - Street 1:2385 LAWRENCEVILLE HWY STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3168
Practice Address - Country:US
Practice Address - Phone:404-289-4270
Practice Address - Fax:404-289-4428
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007746225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist