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General NPI Number Information
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NPI Number | 1104330679
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Entity Type | Individual
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Provider Name | JACOB PALMER ADAMS MSOTR/L
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Gender | Male
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | 2860 E STATE ROAD 61
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City | VINCENNES
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State | IN
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Zip | 47591-9056
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Country | US
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Telephone | 812-887-1219
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Fax |
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Provider Business Mailing Address
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Address Line | 2860 E STATE ROAD 61
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City | VINCENNES
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State | IN
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Zip | 47591-9056
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Country | US
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Telephone | 812-887-1219
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5036
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 17203
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License Number State | CA
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