Provider Demographics
NPI:1083454854
Name:JACOB, CAROLINE (OTD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7507 HUNTERS POINT DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6477
Mailing Address - Country:US
Mailing Address - Phone:281-660-1833
Mailing Address - Fax:
Practice Address - Street 1:2999 OLYMPUS BLVD STE 500
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-1205
Practice Address - Country:US
Practice Address - Phone:866-871-8519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT26015225X00000X
AZOTH-009625225X00000X
TX123742225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist