Provider Demographics
NPI:1407009475
Name:DARBOUZE, JASMINE THERESA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:THERESA
Last Name:DARBOUZE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ELLA STREET
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:917-841-5820
Mailing Address - Fax:888-278-1472
Practice Address - Street 1:39 ELLA STREET
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:917-841-5820
Practice Address - Fax:888-278-1472
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008913225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist