Healthcare Provider Details

I. General information

NPI: 1568114007
Provider Name (Legal Business Name): JASMINE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9514 CONSOLE DR STE 102
SAN ANTONIO TX
78229-2042
US

IV. Provider business mailing address

2810 BABCOCK RD APT 1508
SAN ANTONIO TX
78229-0040
US

V. Phone/Fax

Practice location:
  • Phone: 210-448-9111
  • Fax:
Mailing address:
  • Phone: 520-390-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number121381
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: