Provider Demographics
NPI:1275986622
Name:JACOBI, MONICA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:JACOBI
Suffix:
Gender:F
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 1:3501 E GORE BLVD
Mailing Address - Street 2:APT. 611
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-9813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 SW A AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3951
Practice Address - Country:US
Practice Address - Phone:580-353-8900
Practice Address - Fax:580-353-8903
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2043225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist