Individual
MS. JASMINE ANDREA GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1670 CLAIRMONT RD, DECATUR, GA 30033-4004
(404) 321-6111
Mailing address
219 CALIBRE SPRINGS WAY NE, ATLANTA, GA 30342
(404) 321-6111
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT004868
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT004868
GEORGIA BOARD OF OCCUPATIONAL THERAPY LICENSE
GA
Enumeration date
10/15/2012
Last updated
10/15/2012
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