Provider Demographics
NPI:1972977437
Name:PATEL, JASMIN (COTA)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:PATEL
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 1:128 COTTONWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-3912
Mailing Address - Country:US
Mailing Address - Phone:770-377-1308
Mailing Address - Fax:
Practice Address - Street 1:128 COTTONWOOD TRL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-3912
Practice Address - Country:US
Practice Address - Phone:770-377-1308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12748224Z00000X
GA002142224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12748OtherFL OTA LISCENSE
GA002142OtherGA OTA LICENSE
TX212405OtherTX OTA LICENSE