Provider Demographics
NPI:1023522679
Name:PHILLIPS, JASMIN (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9439 PALLADIUM HTS UNIT D203
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1548
Mailing Address - Country:US
Mailing Address - Phone:330-219-3179
Mailing Address - Fax:
Practice Address - Street 1:4601 EAGLERIDGE PL STE 140
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-4101
Practice Address - Country:US
Practice Address - Phone:719-253-7727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics