Provider Demographics
NPI:1194588970
Name:JACOBSON, SKYLER MARIE (OTD)
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:MARIE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SHARON LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64747-9201
Mailing Address - Country:US
Mailing Address - Phone:913-961-7514
Mailing Address - Fax:
Practice Address - Street 1:103 SHARON LN
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MO
Practice Address - Zip Code:64747-9201
Practice Address - Country:US
Practice Address - Phone:913-961-7514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024004452225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics