Individual
WENDY LISSETTE JACOBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT
Contact information
Practice address
3310 LAKELAND HILLS BLVD, LAKELAND, FL 33805-1974
(863) 802-6600
(863) 802-6639
Mailing address
3615 VICTORIA MANOR DR APT 307, LAKELAND, FL 33805-2976
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
14319
FL
Other
Enumeration date
12/13/2010
Last updated
12/13/2010
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