Provider Demographics
NPI:1407001027
Name:JACOBY, MELISSA A (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:JACOBY
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 1:748 APPLEWINE CT
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-6466
Mailing Address - Country:US
Mailing Address - Phone:717-767-1881
Mailing Address - Fax:
Practice Address - Street 1:1770 BARLEY RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-2223
Practice Address - Country:US
Practice Address - Phone:717-767-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1645216S225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist