Provider Demographics
NPI:1578703039
Name:JACOBS, KATHRYN A (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:FURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:89 DEAN RD
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-9593
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:89 DEAN RD
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-9593
Practice Address - Country:US
Practice Address - Phone:315-292-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015891-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist