Provider Demographics
NPI:1215603204
Name:SZYMANSKI, JACOB (OTR/L)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:SZYMANSKI
Suffix:
Gender:M
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 1:1100 COMMERCE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3700
Mailing Address - Country:US
Mailing Address - Phone:262-497-7270
Mailing Address - Fax:
Practice Address - Street 1:2335 S GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4923
Practice Address - Country:US
Practice Address - Phone:262-497-7270
Practice Address - Fax:877-540-0135
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7077-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist