Provider Demographics
NPI:1093995854
Name:RIETCHECK, JOCELYN ROSE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:ROSE
Last Name:RIETCHECK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 HARVARD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-842-0656
Mailing Address - Fax:785-842-0071
Practice Address - Street 1:2200 HARVARD RD
Practice Address - Street 2:LAWRENCE THERAPY SERVICES SUITE 101
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-842-0656
Practice Address - Fax:785-842-0071
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOOC000518225X00000X
KS1700277225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS115530OtherBLUE CROSS
KS176562Medicare UPIN