Individual
MR. COREY JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
712 DOCTORS CT, OSHKOSH, WI 54901-2029
(920) 303-5300
Mailing address
PO BOX 735041, CHICAGO, IL 60673-5041
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6830-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100110834
—
WI
Enumeration date
09/05/2020
Last updated
10/31/2023
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