Provider Demographics
NPI:1629228598
Name:RAPSON, ANDREA JAYNE (OT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JAYNE
Last Name:RAPSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:JAYNE
Other - Last Name:LEUTZINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 876104
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-6104
Mailing Address - Country:US
Mailing Address - Phone:907-982-3897
Mailing Address - Fax:866-283-2986
Practice Address - Street 1:619 S. KGB
Practice Address - Street 2:SUITE G,H
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-982-3897
Practice Address - Fax:866-283-2986
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2195225XP0200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT0031Medicaid