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General NPI Number Information
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NPI Number | 1649347865
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Entity Type | Organization
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Legal Business Name | JACOBSEN THERAPY SERVICES LLC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 2108 TAYLOR AVE SUITE 1100
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City | NORFOLK
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State | NE
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Zip | 68701-4641
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Country | US
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Telephone | 402-371-7545
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Fax | 402-379-0583
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Provider Business Mailing Address
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Address Line | 2108 TAYLOR AVE SUITE 1100
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City | NORFOLK
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State | NE
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Zip | 68701-4641
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Country | US
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Telephone | 402-371-7545
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Fax | 402-379-0583
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TRACY BETH JACOBSEN
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Credential | MA,OTR-L
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Telephone | 402-371-7545
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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 | 460
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License Number State | NE
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