Individual provider Active NPI

Suzanne Ellen Jacobs, OTD, OTR/L

  • Pediatric Occupational Therapist
  • Glenview, IL
National Provider Identifier
1356582118
Registry record updated Apr 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
Practice address
1308 Waukegan Rd
Suite 103
Glenview, IL 60025-3070
Phone
(847) 486-4140
Fax
(847) 486-4145
NPI assigned
Mar 9, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 5, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X Primary

Addresses

Primary practice location

1308 Waukegan Rd
Suite 103
Glenview, IL 60025-3070

Mailing address

1308 Waukegan Rd
Suite 103
Glenview, IL 60025-3070
Phone (847) 486-4140

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Pediatric Therapy Pediatrics Past Accepting new patients
Pediatric Therapy Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270425600000",
    "number": "1356582118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1308 WAUKEGAN RD",
            "address_2": "SUITE 103",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600253070",
            "telephone_number": "847-486-4140",
            "fax_number": "847-486-4145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 WAUKEGAN RD",
            "address_2": "SUITE 103",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600253070",
            "telephone_number": "847-486-4140",
            "fax_number": "847-486-4145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "SUZANNE",
        "middle_name": "ELLEN",
        "name_prefix": "Ms.",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-03-09",
        "last_updated": "2010-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenview, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.