Healthcare Provider Details

I. General information

NPI: 1093345258
Provider Name (Legal Business Name): JASMINE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MAXWELL AVE STE 312
GREENWOOD SC
29646-2641
US

IV. Provider business mailing address

513 CHURCH STREET NORTH EXT
NINETY SIX SC
29666-8728
US

V. Phone/Fax

Practice location:
  • Phone: 864-229-7529
  • Fax:
Mailing address:
  • Phone: 864-992-6586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: