MEDICARE: JASMINE BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056012759	IL

General Provider Information

NPI Number	:	1124689849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE BROWN

Provider Business Mailing Address
First Line	:	8218 S CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-3406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8218 S CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-3406
Country	:	US
Telephone Number	:	773-943-1100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	12/17/2020

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Directions to “ JASMINE BROWN ” Practice Location

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