Provider Demographics
NPI:1578719449
Name:BANET, JACINDA N (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:JACINDA
Middle Name:N
Last Name:BANET
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:JACINDA
Other - Middle Name:N
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1100 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1838
Mailing Address - Country:US
Mailing Address - Phone:502-596-1000
Mailing Address - Fax:502-596-1411
Practice Address - Street 1:1100 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1838
Practice Address - Country:US
Practice Address - Phone:502-596-1000
Practice Address - Fax:502-596-1411
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-A3512224Z00000X
IN32001418A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant