Provider Demographics
NPI:1366567612
Name:JACOBS, JOYCE (MS,OTR)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MS,OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7899 BRISTOL WAY
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-8786
Mailing Address - Country:US
Mailing Address - Phone:317-440-3690
Mailing Address - Fax:317-861-9329
Practice Address - Street 1:7899 BRISTOL WAY
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-8786
Practice Address - Country:US
Practice Address - Phone:317-440-3690
Practice Address - Fax:317-861-9329
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000104A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200612430Medicaid