Provider Demographics
NPI:1467812685
Name:RAUSCH, ANDREA M (BA-ECSE)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:M
Last Name:RAUSCH
Suffix:
Gender:F
Credentials:BA-ECSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308B E OAK ST
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-1186
Mailing Address - Country:US
Mailing Address - Phone:208-406-4468
Mailing Address - Fax:
Practice Address - Street 1:421 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4008
Practice Address - Country:US
Practice Address - Phone:208-705-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist