Provider Demographics
NPI:1881259331
Name:JOHNSON, JASMINE (COTA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43971-1140
Mailing Address - Country:US
Mailing Address - Phone:304-218-3533
Mailing Address - Fax:
Practice Address - Street 1:330 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:OH
Practice Address - Zip Code:43971-1140
Practice Address - Country:US
Practice Address - Phone:304-218-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA007428224Z00000X
WVC2247224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant