Provider Demographics
NPI:1053994806
Name:NESTOR, JACOB (OT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:NESTOR
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1788 N WILLOW WOODS DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1449
Mailing Address - Country:US
Mailing Address - Phone:714-329-4954
Mailing Address - Fax:
Practice Address - Street 1:4220 132ND ST SE STE 101
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-8999
Practice Address - Country:US
Practice Address - Phone:425-686-7655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
452077225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist