Provider Demographics
NPI:1053783217
Name:JACOBS, MEGAN LYNN (OT)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LYNN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 HIGHWAY US 2
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL FALLS
Mailing Address - State:MI
Mailing Address - Zip Code:49920-9633
Mailing Address - Country:US
Mailing Address - Phone:906-874-1444
Mailing Address - Fax:906-874-1442
Practice Address - Street 1:1523 HIGHWAY US 2
Practice Address - Street 2:
Practice Address - City:CRYSTAL FALLS
Practice Address - State:MI
Practice Address - Zip Code:49920-9633
Practice Address - Country:US
Practice Address - Phone:906-874-1444
Practice Address - Fax:906-874-1442
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility