Individual
MRS. TAMMIE JEAN JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3624 CR 12, MELROSE, NM 88124-9400
(575) 760-0978
Mailing address
PO BOX 570, MELROSE, NM 88124-0570
(575) 760-0978
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2385
NM
Other
Enumeration date
04/28/2010
Last updated
04/28/2010
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