Provider Demographics
NPI:1174847297
Name:JACOBS, RACHEL KING (LMT)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:KING
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3C OLD GLEN CHARLIE RD
Mailing Address - Street 2:
Mailing Address - City:EAST WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02538-1219
Mailing Address - Country:US
Mailing Address - Phone:508-525-2468
Mailing Address - Fax:
Practice Address - Street 1:74 LONG POND RD
Practice Address - Street 2:SUITE 1 C
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2605
Practice Address - Country:US
Practice Address - Phone:508-732-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7896225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist