Healthcare Provider Details

I. General information

NPI: 1912843251
Provider Name (Legal Business Name): JASMINE ROSHAE SIMPSON OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 LONGWOOD AVE
ROCKLEDGE FL
32955-2827
US

IV. Provider business mailing address

107 LONGWOOD AVE
ROCKLEDGE FL
32955-2827
US

V. Phone/Fax

Practice location:
  • Phone: 321-338-2419
  • Fax:
Mailing address:
  • Phone: 321-338-2419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA20559
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: