Provider Demographics
NPI:1407198922
Name:JACOBS, AARON M (OT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:M
Last Name:JACOBS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 KING RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-4438
Mailing Address - Country:US
Mailing Address - Phone:419-517-8200
Mailing Address - Fax:419-517-8209
Practice Address - Street 1:4121 KING RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-4438
Practice Address - Country:US
Practice Address - Phone:419-517-8200
Practice Address - Fax:419-517-8209
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT008263225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1609899061OtherCORPORATE NPI