Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 46TR001259 | NJ |
NPI | 1104870765 |
---|---|
Provider Name | Mrs. Shobha Jacob |
First Address | Little Falls, NJ 07424-0075 |
Second Address | Clifton, NJ 07012-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 25/09/2019 |