MEDICARE: ASHLEY JACOBS

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
1	224Z00000X	Occupational Therapy Assistant	A01938	MD

General Provider Information

NPI Number	:	1841726213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY JACOBS

Provider Business Mailing Address
First Line	:	4224 SLATER AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21236-2720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4224 SLATER AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21236-2720
Country	:	US
Telephone Number	:	410-527-1274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	05/04/2017

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Directions to “ ASHLEY JACOBS ” Practice Location

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