Provider Demographics
NPI:1780388488
Name:PROCTOR, JASMINE CHASTITY (OTR/L)
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:CHASTITY
Last Name:PROCTOR
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 1:4050 WARNER DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-8537
Mailing Address - Country:US
Mailing Address - Phone:601-941-9636
Mailing Address - Fax:
Practice Address - Street 1:27910 MS-18
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083
Practice Address - Country:US
Practice Address - Phone:601-574-7388
Practice Address - Fax:601-894-3676
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4008225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist