Provider Demographics
NPI:1336850346
Name:TERRY, JASON DANIEL (COTA)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:DANIEL
Last Name:TERRY
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SCENIC TRACE DR NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-4494
Mailing Address - Country:US
Mailing Address - Phone:706-346-9088
Mailing Address - Fax:
Practice Address - Street 1:23 SCENIC TRACE DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4494
Practice Address - Country:US
Practice Address - Phone:706-346-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001478224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant