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General NPI Number Information
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NPI Number | 1780312058
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Entity Type | Individual
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Provider Name | DANIELLE JACOBSON
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Gender | Female
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 75 WATERHOUSE RD
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City | BOURNE
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State | MA
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Zip | 02532-3899
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Country | US
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Telephone | 508-759-0670
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Fax |
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Provider Business Mailing Address
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Address Line | 107 CHESTER ST
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City | NORTH FALMOUTH
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State | MA
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Zip | 02556-2414
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Country | US
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Telephone | 551-206-0261
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATL22008
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License Number State | MA
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