Provider Demographics
NPI:1780379818
Name:ROGEL, JAZMIN GRISELDA
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:GRISELDA
Last Name:ROGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 AKERS MILL RD SE APT A20
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3272
Mailing Address - Country:US
Mailing Address - Phone:770-298-0367
Mailing Address - Fax:
Practice Address - Street 1:4286 BELLS FERRY RD NW STE 210
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1302
Practice Address - Country:US
Practice Address - Phone:678-401-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008713225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist