Provider Demographics
NPI:1376104026
Name:OT OUTDOORS
Entity Type:Organization
Organization Name:OT OUTDOORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:M,OTR/L
Authorized Official - Phone:858-945-3242
Mailing Address - Street 1:1461 MERRITT DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-7862
Mailing Address - Country:US
Mailing Address - Phone:858-945-3243
Mailing Address - Fax:619-270-7990
Practice Address - Street 1:1461 MERRITT DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-7862
Practice Address - Country:US
Practice Address - Phone:858-945-3243
Practice Address - Fax:619-270-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty