Provider Demographics
NPI:1902441744
Name:SHAH, JASMINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 PAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-6200
Mailing Address - Country:US
Mailing Address - Phone:919-539-8920
Mailing Address - Fax:
Practice Address - Street 1:303 PAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-6200
Practice Address - Country:US
Practice Address - Phone:919-539-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12918225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty