Provider Demographics
NPI:1225224439
Name:RAPPAPORT, JENNIFER GWENDOLYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GWENDOLYN
Last Name:RAPPAPORT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:2710 SE 79TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-1708
Practice Address - Country:US
Practice Address - Phone:503-380-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR233730225X00000X
WAOT60016311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218419Medicaid
WA0228643OtherWASHINGTON L&I
ORR140967Medicare PIN
WAG8901678Medicare PIN
ORG8886266Medicare PIN
ORR140560Medicare PIN
ORR157607Medicare PIN
WAG8873613Medicare PIN
WA0228643OtherWASHINGTON L&I
ORR140968Medicare PIN
ORR155352Medicare PIN
OR218419Medicaid
ORR140966Medicare PIN
ORR141001Medicare PIN
ORR162809Medicare PIN
ORG8897778Medicare PIN
ORR169685Medicare PIN