Provider Demographics
NPI:1285182964
Name:CUSHION, JAVARIS (OTR)
Entity Type:Individual
Prefix:
First Name:JAVARIS
Middle Name:
Last Name:CUSHION
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 MORSE OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-8554
Mailing Address - Country:US
Mailing Address - Phone:904-982-5705
Mailing Address - Fax:
Practice Address - Street 1:6207 MORSE OAKS CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-8554
Practice Address - Country:US
Practice Address - Phone:904-982-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16701225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist