Provider Demographics
NPI:1760703953
Name:JACOBS, MICHELE LOIS (OTR)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LOIS
Last Name:JACOBS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2438
Mailing Address - Country:US
Mailing Address - Phone:718-339-7812
Mailing Address - Fax:718-339-0428
Practice Address - Street 1:1868 E 26TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2438
Practice Address - Country:US
Practice Address - Phone:718-339-7812
Practice Address - Fax:718-339-0428
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001729-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics