Provider Demographics
NPI:1013598127
Name:JACOBS, CARLY (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E 35TH ST APT 8G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3821
Mailing Address - Country:US
Mailing Address - Phone:732-850-0662
Mailing Address - Fax:
Practice Address - Street 1:37 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3901
Practice Address - Country:US
Practice Address - Phone:718-636-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist