Provider Demographics
NPI:1295205458
Name:HARRIS, JAZMINE CHANELL (COTA)
Entity Type:Individual
Prefix:
First Name:JAZMINE
Middle Name:CHANELL
Last Name:HARRIS
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 1:9B KINGERY QUARTER APT 207
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6569
Mailing Address - Country:US
Mailing Address - Phone:630-854-1297
Mailing Address - Fax:
Practice Address - Street 1:310 BANBURY RD
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1260
Practice Address - Country:US
Practice Address - Phone:630-892-7627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant