IndividualActive
Courtney Jacob
NPI 1053299016 · Pediatric Occupational Therapist · Bend, OR
Provider details
- NPI number
- 1053299016
- Entity type
- Individual
- Primary specialty
- Pediatric Occupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Sole proprietor
- Yes
- License
- 455975 (OR)
Practice location
120 Sw Crowell Way Ste 100
Bend, OR 97702-3429
Phone: (541) 617-8769
Mailing address
62909 Nasu Park Loop
Bend, OR 97701-9775
Registry dates
- Enumerated
- 2025-08-26
- Last updated
- 2025-08-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.