Provider Demographics
NPI:1477250181
Name:NESSER, JACOB ISAAC (OTR/L)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ISAAC
Last Name:NESSER
Suffix:
Gender:M
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 1:116 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5970
Mailing Address - Country:US
Mailing Address - Phone:724-961-4007
Mailing Address - Fax:
Practice Address - Street 1:1801 FOLKEMER CIR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-1771
Practice Address - Country:US
Practice Address - Phone:717-764-9994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119009824225X00000X
PAOC019050225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC019050Medicaid
VA0119009824Medicaid