Provider Demographics
NPI:1821494261
Name:JACOBS, ELICIA MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:ELICIA
Middle Name:MARIE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-4930
Mailing Address - Country:US
Mailing Address - Phone:925-245-1879
Mailing Address - Fax:
Practice Address - Street 1:366 SCOTT ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-4930
Practice Address - Country:US
Practice Address - Phone:925-245-1879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer