Individual
MARY LYNN JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
101 UNIVERSITY DR, SUITE A-6, AMHERST, MA 01002-2473
(413) 366-5703
(413) 992-2019
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1391
MA
225XH1200X
Hand Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000035317
BOSTON HEALTNET
MA
05
—
0389005
—
MA
01
—
043527
CONNECTICARE
MA
01
—
043527497
GREATWEST
MA
01
—
103355100
DEPT OF LABOR
MA
01
—
110001391MA02
ANTHEM
—
01
—
11222870
CAQH
—
01
—
4214936
AETNA-INDIV #
MA
01
—
469635
TUFTS-IND #
MA
01
—
670001710
RAILROAD MEDICARE
MA
01
—
690675
TUFTS
MA
01
—
7710306
CIGNA INDIV #
MA
05
—
9715568
—
MA
01
—
972730
NETWORK HEALTH
MA
01
—
OG0011
BC BS GROUP #
MA
01
—
OT0046
BC/BS INDIV PROVIDER #
MA
01
—
P328227
OXFORD
—
Enumeration date
10/26/2006
Last updated
05/03/2017
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