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General NPI Number Information
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NPI Number | 1578838926
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Entity Type | Individual
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Provider Name | JAMIE FRANCES JACOBSEN MOT
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Gender | Female
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 5115 STATE ROAD 13 N
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-1422
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Country | US
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Telephone | 904-759-1709
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Fax |
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Provider Business Mailing Address
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Address Line | 5115 STATE ROAD 13 N
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-1422
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Country | US
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Telephone | 904-759-1709
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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 | OT14338
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License Number State | FL
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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 | 056009380
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 63017211
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License Number State | NY
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