Provider Demographics
NPI:1639065113
Name:JACOBS, ASHLEY JAMILA (OTD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JAMILA
Last Name:JACOBS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 PETERSON PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-1210
Mailing Address - Country:US
Mailing Address - Phone:407-342-0481
Mailing Address - Fax:
Practice Address - Street 1:12301 LAKE UNDERHILL RD STE 249
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4513
Practice Address - Country:US
Practice Address - Phone:407-249-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT25993225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist