Provider Demographics
NPI:1710159785
Name:JACOBS, MARSHA (MAC)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2313
Mailing Address - Country:US
Mailing Address - Phone:978-852-6489
Mailing Address - Fax:
Practice Address - Street 1:62 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-2313
Practice Address - Country:US
Practice Address - Phone:978-852-6489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208644171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist