Provider Demographics
NPI:1164727244
Name:JACOB, ALISON BETH (MOT, OTR)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:BETH
Last Name:JACOB
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9449 HIGHEDGE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2532
Mailing Address - Country:US
Mailing Address - Phone:214-341-2641
Mailing Address - Fax:
Practice Address - Street 1:9449 HIGHEDGE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2532
Practice Address - Country:US
Practice Address - Phone:214-341-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111392225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist