Provider Demographics
NPI:1790009249
Name:JACOBO, ARLICE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ARLICE
Middle Name:
Last Name:JACOBO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BEAUMONT ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71646-2627
Mailing Address - Country:US
Mailing Address - Phone:870-918-5048
Mailing Address - Fax:
Practice Address - Street 1:1036 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:AR
Practice Address - Zip Code:71646-8980
Practice Address - Country:US
Practice Address - Phone:870-853-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2156225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist