| Doctor Name: | MRS. MARILEEN ANN JACOBS |
| NPI Number: | 1023019494 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1512 E Gilbert Ave Coeur D Alene, ID - 838156216 |
| Business Phone Number: | 2086644398 |
| Business Fax Number: | 2086674733 |
| Mailing Address: | 1512 E Gilbert Ave, COEUR D ALENE |
| State: | ID |
| Postal Code: | 838156216 |
| Phone Number: | 2086644398 |
| Fax Number: | 2086674733 |
| NPI Enumeration Date: | 08/09/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Orthotic Fitter |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the management of fitting prefabricated orthoses. |