Individual
MRS. TRACY JACOBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA OTRL
Contact information
Practice address
2108 TAYLOR AVE, SUITE 1100, NORFOLK, NE 68701-4641
(407) 371-7545
(402) 379-0583
Mailing address
PO BOX 855, WISNER, NE 68791
(402) 529-3267
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
460
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02429
BCBS
NE
01
—
P00472371
RAILROAD MEDICARE
NE
Enumeration date
08/31/2006
Last updated
06/05/2008
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