Provider Demographics
NPI:1992493415
Name:MILLS, JASMINE GABRELLE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:GABRELLE
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10317 SALTBUSH CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3263
Mailing Address - Country:US
Mailing Address - Phone:301-257-3007
Mailing Address - Fax:
Practice Address - Street 1:2222 COLTS NECK RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-2843
Practice Address - Country:US
Practice Address - Phone:301-257-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09698225X00000X
VA0119009625225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist