Provider Demographics
NPI:1851112510
Name:HICKEY, JASMINE MAE (MOT, BSN, OTR/L, RN)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MAE
Last Name:HICKEY
Suffix:
Gender:F
Credentials:MOT, BSN, OTR/L, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 HOUSEL CRAFT RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44402-9602
Mailing Address - Country:US
Mailing Address - Phone:330-240-4785
Mailing Address - Fax:
Practice Address - Street 1:6000 YOUNGSTOWN WARREN RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4624
Practice Address - Country:US
Practice Address - Phone:330-505-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.494791163WP0200X
OHOT013078225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics