Provider Demographics
NPI:1649347865
Name:JACOBSEN THERAPY SERVICES LLC
Entity type:Organization
Organization Name:JACOBSEN THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:JACOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA,OTR-L
Authorized Official - Phone:402-371-7545
Mailing Address - Street 1:2108 TAYLOR AVE
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4641
Mailing Address - Country:US
Mailing Address - Phone:402-371-7545
Mailing Address - Fax:402-379-0583
Practice Address - Street 1:2108 TAYLOR AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4641
Practice Address - Country:US
Practice Address - Phone:402-371-7545
Practice Address - Fax:402-379-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE460225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEF252114OtherMIDLANDS CHOICE
NEDG0558OtherRAILROAD MEDICARE
NE10025464700Medicaid
NE10025464700Medicaid