Provider Demographics
NPI:1104330679
Name:ADAMS, JACOB PALMER (MSOTR/L)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:PALMER
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 E STATE ROAD 61
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-9056
Mailing Address - Country:US
Mailing Address - Phone:812-887-1219
Mailing Address - Fax:
Practice Address - Street 1:2860 E STATE ROAD 61
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-9056
Practice Address - Country:US
Practice Address - Phone:812-887-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5036225X00000X
CA17203225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist