Individual
MRS. MARILEEN ANN JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1512 E GILBERT AVE, COEUR D ALENE, ID 83815-6216
(208) 664-4398
(208) 667-4733
Mailing address
1512 E GILBERT AVE, COEUR D ALENE, ID 83815-6216
(208) 664-4398
(208) 667-4733
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010014587
REGENCE BLUE SHIELD
ID
01
—
8A760
BLUE CROSS
ID
Enumeration date
08/09/2005
Last updated
07/08/2007
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