Individual
JASMINE N BRADDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
619 HARRISON ST, PUEBLO, CO 81004-1457
(850) 723-1642
Mailing address
619 HARRISON ST, PUEBLO, CO 81004-1457
(850) 723-1642
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT.0005157
CO
Other
Enumeration date
11/30/2020
Last updated
11/30/2020
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