Provider Demographics
NPI:1518235738
Name:NORTH, JACOB (MAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:NORTH
Suffix:
Gender:M
Credentials:MAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 RAILROAD ST.
Mailing Address - Street 2:P.O. BOX 197
Mailing Address - City:ANTWERP
Mailing Address - State:OH
Mailing Address - Zip Code:45813
Mailing Address - Country:US
Mailing Address - Phone:419-672-8388
Mailing Address - Fax:
Practice Address - Street 1:307 RAILROAD ST.
Practice Address - Street 2:
Practice Address - City:ANTWERP
Practice Address - State:OH
Practice Address - Zip Code:45813
Practice Address - Country:US
Practice Address - Phone:419-672-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT 0036482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer