Provider Demographics
NPI:1730158866
Name:JACOBSON, KIMBERLY S (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:S
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11750 51ST AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2144
Mailing Address - Country:US
Mailing Address - Phone:763-559-1696
Mailing Address - Fax:
Practice Address - Street 1:555 RAILROAD DR NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1444
Practice Address - Country:US
Practice Address - Phone:763-441-8111
Practice Address - Fax:763-441-9015
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100435225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand