Healthcare Provider Details

I. General information

NPI: 1972424190
Provider Name (Legal Business Name): JASMINE L ESPANA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6169 S JOG RD STE A11
LAKE WORTH FL
33467-6586
US

IV. Provider business mailing address

5840 CORPORATE WAY STE 101
WEST PALM BEACH FL
33407-2040
US

V. Phone/Fax

Practice location:
  • Phone: 561-432-0111
  • Fax: 561-432-1075
Mailing address:
  • Phone: 561-432-0111
  • Fax: 561-432-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT26246
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: