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General NPI Number Information
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NPI Number | 1831739531
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Entity Type | Individual
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Provider Name | JASON WASHBURN OTR/L, LMT, CLT
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Gender | Male
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Dates
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Enumeration Date | 01/10/2020
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 2121 RICHMOND RD STE 210
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City | LEXINGTON
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State | KY
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Zip | 40502-1213
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Country | US
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Telephone | 859-979-6480
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Fax |
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Provider Business Mailing Address
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Address Line | 522 SOUTHERN CROSS DR
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City | RICHMOND
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State | KY
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Zip | 40475-7037
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Country | US
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Telephone | 859-979-2092
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 252738
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 107028
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License Number State | KY
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