Provider Demographics
NPI:1871816678
Name:JACOBSON, RENEE M (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:M
Last Name:JACOBSON
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 1:1356 NE HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-2603
Mailing Address - Country:US
Mailing Address - Phone:503-502-9456
Mailing Address - Fax:
Practice Address - Street 1:1356 NE HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-2603
Practice Address - Country:US
Practice Address - Phone:503-502-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3374225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist