Carrie Renee Jacobs, MBA, OTRL, C/NDT

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

5201004063 Issued in MI

Practice address

11930 Whitmore Lake Rd.
Suite I-M
Whitmore Lake, MI 48189

Phone

(734) 449-4649

Fax

(734) 449-4669

NPI assigned

Dec 8, 2006

Sex

Female

Sole proprietor

No

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

Credentials

Master of Business Administration

State licenses

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361145600000",
    "number": "1700946142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11930 WHITMORE LAKE RD.",
            "address_2": "SUITE I-M",
            "city": "WHITMORE LAKE",
            "state": "MI",
            "postal_code": "48189",
            "telephone_number": "734-449-4649",
            "fax_number": "734-449-4669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11930 WHITMORE LAKE RD.",
            "address_2": "SUITE I-M",
            "city": "WHITMORE LAKE",
            "state": "MI",
            "postal_code": "48189",
            "telephone_number": "734-449-4649",
            "fax_number": "734-449-4669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "CARRIE",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "MBA, OTRL, C/NDT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-08",
        "last_updated": "2013-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "MI",
            "license": "5201004063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eugene Zamudio Hernandez, LPC
• Kerry Kathleen Hurley, M.S., CCC-SLP
• Integrative Care Services
• International Health Care Properties
• Richard Keith Isgrigg, DDS
• Alissa Jahn, MA, LLPC, ATR-P
• Sithara Jaison, N.P
• Brian Johnson
• Kamal Kaur
• Kathleen Kawel

• Pediatric Occupational Therapist in Whitmore Lake, MI
• Providers in Whitmore Lake, 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 Feb 18, 2013; 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.