Provider Demographics
NPI:1912562414
Name:JACOBS, JO ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 OTTAWA ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2337
Mailing Address - Country:US
Mailing Address - Phone:814-266-8621
Mailing Address - Fax:888-510-3360
Practice Address - Street 1:207 OTTAWA ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2337
Practice Address - Country:US
Practice Address - Phone:814-266-8621
Practice Address - Fax:888-510-3360
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP000126L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant