Provider Demographics
NPI:1073083978
Name:DOTSETH, JACOB D
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:D
Last Name:DOTSETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 PINE ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD CITY
Mailing Address - State:WI
Mailing Address - Zip Code:54013-8537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:446 PINE ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD CITY
Practice Address - State:WI
Practice Address - Zip Code:54013-8537
Practice Address - Country:US
Practice Address - Phone:715-461-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer