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Individual

MRS. KIMBERLY ILEANA JACOBS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
1405 MILL ST, NEW LONDON, WI 54961-2155
(920) 531-2031
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(920) 531-2031

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3746-026
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
40753300
WI
Enumeration date
10/03/2006
Last updated
08/06/2025
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