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General NPI Number Information
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NPI Number | 1972151470
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Entity Type | Individual
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Provider Name | JASMINE F COLON COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 1001 SW A AVE
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City | LAWTON
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State | OK
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Zip | 73501-3951
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Country | US
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Telephone | 732-505-7658
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 NW TAYLOR AVE UNIT C
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City | LAWTON
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State | OK
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Zip | 73507-3884
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Country | US
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Telephone | 580-928-7210
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OTA17412
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 2651
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License Number State | OK
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