Individual
JAZMINE ANN LAVERGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
30 WILLOW TRACE DR, PHENIX CITY, AL 36869-7105
(404) 966-0479
Mailing address
30 WILLOW TRACE DR, PHENIX CITY, AL 36869-7105
(404) 966-0479
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA002816
GA
Other
Enumeration date
10/13/2022
Last updated
10/13/2022
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