Provider Demographics
NPI:1568352987
Name:LIBERTY, JASMINE DAWN MARIE (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:DAWN MARIE
Last Name:LIBERTY
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 SUNSET AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-3528
Mailing Address - Country:US
Mailing Address - Phone:207-680-0642
Mailing Address - Fax:
Practice Address - Street 1:4761 TUTTLE CREEK BLVD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-9079
Practice Address - Country:US
Practice Address - Phone:785-587-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-06363225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics