Provider Demographics
NPI:1558877233
Name:RUSCHEWSKI, JAYLA (OT)
Entity Type:Individual
Prefix:
First Name:JAYLA
Middle Name:
Last Name:RUSCHEWSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JAYLA
Other - Middle Name:
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1129 CHEW FORKS RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:MS
Mailing Address - Zip Code:39039-9018
Mailing Address - Country:US
Mailing Address - Phone:662-207-1322
Mailing Address - Fax:
Practice Address - Street 1:1129 CHEW FORKS RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:MS
Practice Address - Zip Code:39039-9018
Practice Address - Country:US
Practice Address - Phone:662-207-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3352225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist