MEDICARE: MRS. ALISON BETH JACOB MOT, OTR

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	225X00000X	Occupational Therapist	111392	TX

General Provider Information

NPI Number	:	1164727244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISON BETH JACOB MOT, OTR

Provider Business Mailing Address
First Line	:	9449 HIGHEDGE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-2532
Country	:	US
Telephone Number	:	214-341-2641
Fax Number	:

Provider Business Practice Location Address
First Line	:	9449 HIGHEDGE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-2532
Country	:	US
Telephone Number	:	214-341-2641
Fax Number	:

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

Provider Enumeration Date	:	01/20/2011
Last Update Date	:	01/20/2011

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