Provider Demographics
NPI:1770793929
Name:AGBAYANI, JAYME LEE (OT)
Entity type:Individual
Prefix:
First Name:JAYME
Middle Name:LEE
Last Name:AGBAYANI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CANARY CT
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-3970
Mailing Address - Country:US
Mailing Address - Phone:415-218-3137
Mailing Address - Fax:
Practice Address - Street 1:310 PENSACOLA RD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-3318
Practice Address - Country:US
Practice Address - Phone:828-682-9759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6421225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist