Provider Demographics
NPI:1508297557
Name:JACOBS, CINDY LOU (OTR/L)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:LOU
Last Name:JACOBS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:LOU
Other - Last Name:PELLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:9985 AMSDEN WAY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-3016
Mailing Address - Country:US
Mailing Address - Phone:952-797-2169
Mailing Address - Fax:
Practice Address - Street 1:9985 AMSDEN WAY
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-3016
Practice Address - Country:US
Practice Address - Phone:952-797-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103099225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist