Individual
JACOB LIBBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTRL
Contact information
Practice address
1717 E CHICAGO RD, SUITE 1, STURGIS, MI 49091-8524
(269) 659-4468
(269) 659-2744
Mailing address
1717 E CHICAGO RD, SUITE 1, STURGIS, MI 49091-8524
(269) 659-4468
(269) 659-2744
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201007506
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5201007506
MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI
Enumeration date
01/15/2016
Last updated
01/15/2016
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