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NPI Code Detail

MEDICARE: JACOB COLBY OTR/L

MEDICARE: JACOB COLBY OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist11055192-4201UT

General Provider Information

NPI Number : 1275176810
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB COLBY OTR/L
Provider Business Mailing Address
First Line : 1480 N 400 E
Second Line :
City : LOGAN
State : UT
Zip : 84341-7525
Country : US
Telephone Number : 801-808-4115
Fax Number :
Provider Business Practice Location Address
First Line : 1480 N 400 E
Second Line :
City : LOGAN
State : UT
Zip : 84341-7525
Country : US
Telephone Number : 801-808-4115
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2019
Last Update Date : 10/27/2019

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Directions to “ JACOB COLBY OTR/L” Practice Location

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