Emmie Jacobson, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

202761 Issued in MN

Practice address

310 Red Lake Blvd
Thief River Falls, MN 56701-2133

Phone

(218) 416-1482

Fax

(218) 416-1483

NPI assigned

Oct 17, 2023

Sex

Female

Sole proprietor

No

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.

• Pediatric Therapy Partners, Inc.

  • Occupational Therapist
  • Thief River Falls, MN
  • NPI 1457479958
  NPD

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 17, 2023.

{
    "created_epoch": "1697500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1508648353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3060 FRONTIER WAY S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048909",
            "telephone_number": "701-232-2340",
            "fax_number": "701-232-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 RED LAKE BLVD",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567012133",
            "telephone_number": "218-416-1482",
            "fax_number": "218-416-1483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "EMMIE",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-17",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MN",
            "license": "202761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle J Hoff, PT
• Ashley Lauren Holtan, MS, CCC-SLP
• Hope Pediatrics PLLC
• Samantha Jean Hulst, CNP
• John H Imsande, CRNA
• Elizabeth L Jahn, RN, MSN, FNP
• Patrick Jahn, NP
• Justine Janecek, CCC-SLP
• Jennifer a. Manning
• Jgsteinhauer PLLC

• All providers in Thief River Falls, MN
• Occupational Therapy Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; 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.