Provider Demographics
NPI:1427397850
Name:JACOBS, CORRIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:JACOBS
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 1:141 DEERFIELD LN N
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-1430
Mailing Address - Country:US
Mailing Address - Phone:845-598-3731
Mailing Address - Fax:
Practice Address - Street 1:141 DEERFIELD LN N
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-1430
Practice Address - Country:US
Practice Address - Phone:845-598-3731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013188-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist