Provider Demographics
NPI:1083867154
Name:RAUCH, JENNIFER P (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:P
Last Name:RAUCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:110 OAKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-8642
Mailing Address - Country:US
Mailing Address - Phone:812-342-0198
Mailing Address - Fax:812-342-0198
Practice Address - Street 1:4895 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2569
Practice Address - Country:US
Practice Address - Phone:812-342-3098
Practice Address - Fax:812-342-3288
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000571A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant