Provider Demographics
NPI:1659586956
Name:JACOBSON, JESSICA T (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:T
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S 12TH ST
Mailing Address - Street 2:502S
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5556
Mailing Address - Country:US
Mailing Address - Phone:215-667-9311
Mailing Address - Fax:
Practice Address - Street 1:221 S 12TH ST
Practice Address - Street 2:502S
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5556
Practice Address - Country:US
Practice Address - Phone:215-667-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006057224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant