Provider Demographics
NPI:1316381643
Name:ERAZMUS, JASMINE JADEITE JIA (OT)
Entity Type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:JADEITE JIA
Last Name:ERAZMUS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:JADEITE
Other - Last Name:JIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:3850 N MISSISSIPPI AVE APT A613
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1387
Mailing Address - Country:US
Mailing Address - Phone:415-264-7840
Mailing Address - Fax:
Practice Address - Street 1:3850 N MISSISSIPPI AVE APT A613
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1387
Practice Address - Country:US
Practice Address - Phone:415-264-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15757225X00000X
NV120263225X00000X
OR300702225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist