1487751558 NPI number — MRS. MICHELE LEIGH JACOBSON OTR/L

Table of content: MRS. MICHELE LEIGH JACOBSON OTR/L (NPI 1487751558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487751558 NPI number — MRS. MICHELE LEIGH JACOBSON OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBSON
Provider First Name:
MICHELE
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487751558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 DAHLBERG DRIVE, SUITE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDEN VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-512-5637
Provider Business Mailing Address Fax Number:
952-345-7707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 W 140TH ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURNSVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55337-4480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-808-3000
Provider Business Practice Location Address Fax Number:
952-808-3001
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  102354 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com