Provider Demographics
NPI:1801019310
Name:JACOBS, CHRISTINE JULE (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:JULE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12437 TURKEL PL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1270
Mailing Address - Country:US
Mailing Address - Phone:317-596-1062
Mailing Address - Fax:317-596-1062
Practice Address - Street 1:12437 TURKEL PL
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1270
Practice Address - Country:US
Practice Address - Phone:317-596-1062
Practice Address - Fax:317-596-1062
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000364A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics