MEDICARE: MRS. SHOBHA JACOB MS OTR CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XH1200X	Hand Occupational Therapist	46TR001259	NJ

General Provider Information

NPI Number	:	1104870765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHOBHA JACOB MS OTR CHT

Provider Business Mailing Address
First Line	:	PO BOX 75
Second Line	:
City	:	LITTLE FALLS
State	:	NJ
Zip	:	07424-0075
Country	:	US
Telephone Number	:	973-928-5800
Fax Number	:	973-928-5801

Provider Business Practice Location Address
First Line	:	881 ALLWOOD RD STE 101
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07012-1900
Country	:	US
Telephone Number	:	973-928-5800
Fax Number	:	973-928-5801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	09/25/2019

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