Active NPI
Melinda Beth Jacob, COTA
- Skilled Nursing Facility
- Dayton, OH
National Provider Identifier
1184748659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- OTA02908
- Practice address
- 1390 King Tree Dr
Dayton, OH 45405-1401 - Phone
- (937) 278-0723
- NPI assigned
- Mar 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | OTA02908 | OH | Primary |
Addresses
Primary practice location
1390 King Tree Dr
Dayton, OH 45405-1401
Mailing address
5864 Beecham Drive
Huber Heights, OH 45424
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTA02908 | OH | MD | Skilled Nursing Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184748659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5864 BEECHAM DRIVE",
"city": "HUBER HEIGHTS",
"state": "OH",
"postal_code": "45424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1390 KING TREE DR",
"city": "DAYTON",
"state": "OH",
"postal_code": "454051401",
"telephone_number": "937-278-0723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "MELINDA",
"middle_name": "BETH",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "OH",
"license": "OTA02908",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.