Provider Demographics
NPI:1942556311
Name:ADCOCK, JASPER WINTON (DPT, OTR/L, RHIA)
Entity Type:Individual
Prefix:DR
First Name:JASPER
Middle Name:WINTON
Last Name:ADCOCK
Suffix:
Gender:M
Credentials:DPT, OTR/L, RHIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1577
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-1577
Mailing Address - Country:US
Mailing Address - Phone:601-722-2222
Mailing Address - Fax:601-722-4444
Practice Address - Street 1:1074 HIGHWAY 13 N
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-8568
Practice Address - Country:US
Practice Address - Phone:601-825-0101
Practice Address - Fax:601-825-0102
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS5208261QP2000X, 225100000X
MS2664225X00000X, 261QP2000X
MS2255A2300X, 225700000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS3185373Medicaid
MS31853731Medicaid
MS031853731Medicaid