Provider Demographics
NPI:1275252439
Name:BATEMAN, JASMINE LANIESE (COTA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:LANIESE
Last Name:BATEMAN
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 1:7919 BRIDGESTONE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5390
Mailing Address - Country:US
Mailing Address - Phone:407-394-6252
Mailing Address - Fax:
Practice Address - Street 1:1002 S DILLARD ST STE 106
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3991
Practice Address - Country:US
Practice Address - Phone:407-877-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19102224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant