Individual
THERESA JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
27 AUERBACH PL, GLEN CARBON, IL 62034-1596
(618) 288-3700
Mailing address
6813 MANCHESTER DR, MARYVILLE, IL 62062-8548
(618) 353-4315
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057002769
IL
Other
Enumeration date
06/27/2022
Last updated
06/27/2022
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