Healthcare Provider Details

I. General information

NPI: 1215850946
Provider Name (Legal Business Name): JACOB TERRY MEYERS OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 HALLECK DR
WHITEHALL PA
18052-3805
US

IV. Provider business mailing address

57 MAYFLOWER ST
COLORADO SPRINGS CO
80905-4307
US

V. Phone/Fax

Practice location:
  • Phone: 610-504-7455
  • Fax:
Mailing address:
  • Phone: 610-504-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC018804
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: