Provider Demographics
NPI:1750893749
Name:WARD-DYER, JASMINE (OTR/L)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:WARD-DYER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S HILL ST APT 619
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4678
Mailing Address - Country:US
Mailing Address - Phone:424-326-3616
Mailing Address - Fax:323-797-5064
Practice Address - Street 1:1100 S HILL ST APT 619
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-4678
Practice Address - Country:US
Practice Address - Phone:424-326-3616
Practice Address - Fax:132-379-7506
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60799680225X00000X
CA19314225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist