Provider Demographics
NPI:1003323650
Name:JACOBS, ONICA ANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ONICA
Middle Name:ANNE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 N 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:HARTLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51346-1123
Mailing Address - Country:US
Mailing Address - Phone:712-363-5582
Mailing Address - Fax:
Practice Address - Street 1:1301 SAINT LUKE DR
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-6043
Practice Address - Country:US
Practice Address - Phone:712-262-5931
Practice Address - Fax:712-262-4743
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089282225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology