Organization
INNOVATIVE PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SKYLER MARIE JACOBSON OTD, OTR/L (OWNER)
(913) 961-7514
Entity
Organization
Contact information
Practice address
103 SHARON LN, GARDEN CITY, MO 64747-9201
(913) 961-7514
Mailing address
PO BOX 756, HARRISONVILLE, MO 64701-0756
(913) 961-7514
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
—
—
251300000X
Local Education Agency (LEA)
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194588970
—
MO
Enumeration date
03/25/2024
Last updated
03/25/2024
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