Provider Demographics
NPI:1154064004
Name:PAGAN, JASMINE ASHLEY (COTA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ASHLEY
Last Name:PAGAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8312 NW GREENBANK CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-3046
Mailing Address - Country:US
Mailing Address - Phone:845-416-1306
Mailing Address - Fax:
Practice Address - Street 1:8312 NW GREENBANK CIR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-3046
Practice Address - Country:US
Practice Address - Phone:845-416-1306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics