Provider Demographics
NPI:1497265342
Name:JACOBS, DONALD SCOTT (LMT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:SCOTT
Last Name:JACOBS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 MASON ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-5851
Mailing Address - Country:US
Mailing Address - Phone:606-585-7589
Mailing Address - Fax:
Practice Address - Street 1:3112 MASON ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-5851
Practice Address - Country:US
Practice Address - Phone:606-585-7589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2016-3457225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty