Healthcare Provider Details

I. General information

NPI: 1104287192
Provider Name (Legal Business Name): JASMINE BAUGH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8021 CHRISTIAN CT
LOUISVILLE KY
40222-9050
US

IV. Provider business mailing address

1710 COLONY CT
LOUISVILLE KY
40216-2706
US

V. Phone/Fax

Practice location:
  • Phone: 502-425-2402
  • Fax:
Mailing address:
  • Phone: 502-821-9288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number163770
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberBOTOCT00217413
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: