Provider Demographics
NPI:1689285686
Name:BADY, JASMINE (OTR)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:BADY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 TC LUPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-6216
Mailing Address - Country:US
Mailing Address - Phone:469-758-3456
Mailing Address - Fax:
Practice Address - Street 1:301 TC LUPTON BLVD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-6216
Practice Address - Country:US
Practice Address - Phone:469-758-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125178225X00000X
TNRBT-20-114998106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician