Healthcare Provider Details

I. General information

NPI: 1972436335
Provider Name (Legal Business Name): JAZMA STREETER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 HOLLOWAY ST
DURHAM NC
27703-3522
US

IV. Provider business mailing address

3420 HOLLOWAY ST
DURHAM NC
27703-3522
US

V. Phone/Fax

Practice location:
  • Phone: 772-618-0605
  • Fax: 763-322-2777
Mailing address:
  • Phone: 772-618-0605
  • Fax: 763-322-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18030
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: