MEDICARE: MR. JASON WASHBURN OTR/L, LMT, CLT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	252738	KY
2	225700000X	Massage Therapist	107028	KY

General Provider Information

NPI Number	:	1831739531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON WASHBURN OTR/L, LMT, CLT

Provider Business Mailing Address
First Line	:	522 SOUTHERN CROSS DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-7037
Country	:	US
Telephone Number	:	859-979-2092
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 RICHMOND RD STE 210
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-1213
Country	:	US
Telephone Number	:	859-979-6480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	10/31/2024

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