Individual
COURTNEY JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
120 SW CROWELL WAY STE 100, BEND, OR 97702-3429
(541) 617-8769
Mailing address
62909 NASU PARK LOOP, BEND, OR 97701-9775
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
455975
OR
Other
Enumeration date
08/26/2025
Last updated
08/26/2025
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