Provider Demographics
NPI:1063745115
Name:JACOBS, ADAM S (COTA)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:S
Last Name:JACOBS
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1240
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1240
Mailing Address - Country:US
Mailing Address - Phone:606-325-7955
Mailing Address - Fax:606-325-9848
Practice Address - Street 1:1033 GALLIA ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4140
Practice Address - Country:US
Practice Address - Phone:740-354-5001
Practice Address - Fax:740-354-5011
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA04217225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist