Provider Demographics
NPI:1194530535
Name:RECINOS, JASMIN ADRIANA (COTA)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:ADRIANA
Last Name:RECINOS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:ADRIANA
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:77 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3507
Mailing Address - Country:US
Mailing Address - Phone:860-836-0967
Mailing Address - Fax:
Practice Address - Street 1:915 SULLIVAN AVE STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2165
Practice Address - Country:US
Practice Address - Phone:860-644-2335
Practice Address - Fax:888-974-2148
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1426224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant