Provider Demographics
NPI:1134698715
Name:DAWSON, JASMINE KEANNA (OT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:KEANNA
Last Name:DAWSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 DANTIGNAC ST STE 2100
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2777
Mailing Address - Country:US
Mailing Address - Phone:706-396-0600
Mailing Address - Fax:706-396-0606
Practice Address - Street 1:1303 D'ANTIGNAC STREET
Practice Address - Street 2:SUITE 2100
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2777
Practice Address - Country:US
Practice Address - Phone:706-396-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007206225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics