Provider Demographics
NPI:1386286235
Name:BOURGEOIS, JAYME MICHELE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:JAYME
Middle Name:MICHELE
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9932 SWEET BASIL DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4127
Mailing Address - Country:US
Mailing Address - Phone:732-770-5706
Mailing Address - Fax:919-882-9502
Practice Address - Street 1:140 NORMANDY RD
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-9032
Practice Address - Country:US
Practice Address - Phone:919-495-2543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5022224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant