Provider Demographics
NPI:1962621482
Name:JACOB, SONDRA NADEEN (OTR)
Entity type:Individual
Prefix:MS
First Name:SONDRA
Middle Name:NADEEN
Last Name:JACOB
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LAFAYETTE LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2543
Mailing Address - Country:US
Mailing Address - Phone:856-489-4387
Mailing Address - Fax:
Practice Address - Street 1:201 KINGS HWY S
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2507
Practice Address - Country:US
Practice Address - Phone:856-616-6466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00325100225X00000X
PAOC007260L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist