Provider Demographics
NPI:1861191769
Name:AYOUB, JACOB CHANCE
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:CHANCE
Last Name:AYOUB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14239 W BELL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2470
Mailing Address - Country:US
Mailing Address - Phone:623-544-1631
Mailing Address - Fax:623-975-6144
Practice Address - Street 1:14239 W BELL RD STE 110
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2470
Practice Address - Country:US
Practice Address - Phone:623-544-1631
Practice Address - Fax:623-975-6144
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTH-008907225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist