Healthcare Provider Details

I. General information

NPI: 1437997434
Provider Name (Legal Business Name): JASON LEE ESPINOSA OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 E BOULEVARD
KOKOMO IN
46902-2401
US

IV. Provider business mailing address

2108 E BOULEVARD
KOKOMO IN
46902-2401
US

V. Phone/Fax

Practice location:
  • Phone: 765-416-8480
  • Fax:
Mailing address:
  • Phone: 765-416-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number124632
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31008747A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: