Provider Demographics
NPI:1407554272
Name:RITCHIE, JACQUELYN (COTA/L)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CASSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65625-2010
Mailing Address - Country:US
Mailing Address - Phone:417-342-8148
Mailing Address - Fax:
Practice Address - Street 1:1700 S HUDSON AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2717
Practice Address - Country:US
Practice Address - Phone:417-678-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018012945224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant