Provider Demographics
NPI:1831739531
Name:WASHBURN, JASON (OTR/L, LMT, CLT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:WASHBURN
Suffix:
Gender:M
Credentials:OTR/L, LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 SOUTHERN CROSS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7037
Mailing Address - Country:US
Mailing Address - Phone:859-979-2092
Mailing Address - Fax:
Practice Address - Street 1:2121 RICHMOND RD STE 210
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1213
Practice Address - Country:US
Practice Address - Phone:859-979-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252738225X00000X
KY107028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist