Provider Demographics
NPI:1346771177
Name:BURNOM, JASMINE (OTR; CLT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:BURNOM
Suffix:
Gender:F
Credentials:OTR; CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 W DEAN RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2638
Mailing Address - Country:US
Mailing Address - Phone:414-371-7300
Mailing Address - Fax:414-371-7598
Practice Address - Street 1:7500 W DEAN RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-2638
Practice Address - Country:US
Practice Address - Phone:414-371-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5537-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist