Provider Demographics
NPI:1891950465
Name:JASTER, ANTONIA (COTA)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:JASTER
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 1:5809 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2403
Mailing Address - Country:US
Mailing Address - Phone:520-232-3896
Mailing Address - Fax:
Practice Address - Street 1:6651 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2118
Practice Address - Country:US
Practice Address - Phone:520-731-8533
Practice Address - Fax:520-721-3601
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2681224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant