Individual
LESLIE JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1509 ATKINSON RD, SUITE 1100, LAWRENCEVILLE, GA 30043-7986
(770) 995-2379
(770) 995-2385
Mailing address
1509 ATKINSON RD, SUITE 1100, LAWRENCEVILLE, GA 30043-7986
(770) 995-2379
(770) 995-2385
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
OT001219
GA
225XP0200X
Pediatric Occupational Therapist
Primary
OT001219
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000726778A
—
GA
05
—
10037750
—
GA
05
—
306075
—
GA
Enumeration date
12/13/2006
Last updated
10/27/2010
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