Provider Demographics
NPI:1356635841
Name:JACOBSON, KELLEY LYNN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:LYNN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:LYNN
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4314 WESTBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-3454
Mailing Address - Country:US
Mailing Address - Phone:303-847-6410
Mailing Address - Fax:970-207-1766
Practice Address - Street 1:4314 WESTBROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-3454
Practice Address - Country:US
Practice Address - Phone:303-847-6410
Practice Address - Fax:970-207-1766
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1346225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist