Provider Demographics
NPI:1811778327
Name:CHANEY, JASMINE (OTR/L)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:CHANEY
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 1:201 TAYLOR OAKS CIR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-8539
Mailing Address - Country:US
Mailing Address - Phone:205-639-4983
Mailing Address - Fax:
Practice Address - Street 1:2639 GILMER AVE
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-7231
Practice Address - Country:US
Practice Address - Phone:334-283-3975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5045225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist