Provider Demographics
NPI:1942780648
Name:JAKUBOWSKA, JOANNA BRYGIDA (COTA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:BRYGIDA
Last Name:JAKUBOWSKA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 CIMARRON TRL
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4598
Mailing Address - Country:US
Mailing Address - Phone:214-789-8446
Mailing Address - Fax:
Practice Address - Street 1:3443 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4411
Practice Address - Country:US
Practice Address - Phone:469-586-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211714224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant