Provider Demographics
NPI:1467795492
Name:JACOB, MELISSA (OTR)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SCHOMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:129 LOU JON CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-3354
Mailing Address - Country:US
Mailing Address - Phone:210-274-5147
Mailing Address - Fax:
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:MCHE-QD/CREDENTIALS
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4501
Practice Address - Country:US
Practice Address - Phone:210-916-2460
Practice Address - Fax:210-916-5102
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112294225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist