Provider Demographics
NPI:1457792111
Name:THURSBY, JAMIA LEE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JAMIA
Middle Name:LEE
Last Name:THURSBY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 BESSEMER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-3717
Mailing Address - Country:US
Mailing Address - Phone:941-468-8116
Mailing Address - Fax:
Practice Address - Street 1:10001 FIANA WAY
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72913
Practice Address - Country:US
Practice Address - Phone:941-468-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 289224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant