Samuel Cole Jacobson, OTRL

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

Z3WA3DJZ Issued in MI

Practice address

43279 Schoenherr Rd
Sterling Heights, MI 48313-1957

Phone

(313) 278-4601

NPI assigned

Apr 9, 2024

Last updated

Apr 9, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1712620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1427801471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6861 RICHMOND DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480981594",
            "telephone_number": "248-895-3797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43279 SCHOENHERR RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483131957",
            "telephone_number": "313-278-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "SAMUEL",
        "middle_name": "COLE",
        "credential": "OTRL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-04-09",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "MI",
            "license": "Z3WA3DJZ",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pius Jacob, PHYSICAL THERAPIST
• Sereena Grace Jacob
• Sherine Susan Jacob
• Eduardo Jacobs
• Judy Lynn Jacobs, PHD
• Syed Abbas H. Jafri, M.D.
• Edyta Jagustin, P.T.
• Aditi Jaidka, MD
• Raquel Jairal, PTA
• Isatou Jallow

• Pediatric Occupational Therapist in Sterling Heights, MI
• Providers in Sterling Heights, MI by specialty
• Pediatric Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; 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.