Provider Demographics
NPI:1306480447
Name:LINDSAY, JASMINE SOMONE (COTA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:SOMONE
Last Name:LINDSAY
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 1:293 JAMES WILLIAMS RD LOT 88
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-7577
Mailing Address - Country:US
Mailing Address - Phone:803-944-1814
Mailing Address - Fax:
Practice Address - Street 1:293 JAMES WILLIAMS RD LOT 88
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-7577
Practice Address - Country:US
Practice Address - Phone:803-944-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5059224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant