MEDICARE: JACOB STEWART ANDERSON MA, OTR/L

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	1738	WV
2	225X00000X	Occupational Therapist	12625	NC
3	225X00000X	Occupational Therapist	OTR2444	AR

General Provider Information

NPI Number	:	1356621163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB STEWART ANDERSON MA, OTR/L

Provider Business Mailing Address
First Line	:	2391 BURKE MEMORIAL PARK RD
Second Line	:
City	:	VALDESE
State	:	NC
Zip	:	28690-9534
Country	:	US
Telephone Number	:	304-917-1801
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 EAST PARKER ROAD
Second Line	:	PO DRAWER 989
City	:	MORGANTON
State	:	NC
Zip	:	28655-4647
Country	:	US
Telephone Number	:	828-439-4332
Fax Number	:	828-439-4314

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

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	03/17/2026

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