Provider Demographics
NPI:1972151470
Name:COLON, JASMINE F (COTA/L)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:F
Last Name:COLON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 NW TAYLOR AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-3884
Mailing Address - Country:US
Mailing Address - Phone:580-928-7210
Mailing Address - Fax:
Practice Address - Street 1:1001 SW A AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3951
Practice Address - Country:US
Practice Address - Phone:732-505-7658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2025-07-30
Deactivation Date:2022-11-09
Deactivation Code:
Reactivation Date:2025-07-23
Provider Licenses
StateLicense IDTaxonomies
FLOTA17412225XP0200X
OK2651224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9527941466Medicaid