Individual
JASMINE CORNELL DECOUDRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2600 COMPASS RD, GLENVIEW, IL 60026-8001
(877) 787-3422
Mailing address
1108 E 10TH AVE, WINFIELD, KS 67156-3802
(620) 218-4997
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18-01762
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18-01762
KANSAS BOARD OF HEALING ARTS COTA
KS
01
—
453188
NBCOT/COTA
—
Enumeration date
07/29/2021
Last updated
07/29/2021
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