Provider Demographics
NPI:1770651390
Name:RATTRAY, JARED R (OTR L, CHT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:R
Last Name:RATTRAY
Suffix:
Gender:M
Credentials:OTR L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11009
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1009
Mailing Address - Country:US
Mailing Address - Phone:509-962-1132
Mailing Address - Fax:866-365-5203
Practice Address - Street 1:1205 HIGHWAY 2 STE 102
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2740
Practice Address - Country:US
Practice Address - Phone:800-353-5208
Practice Address - Fax:866-365-5203
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003293208100000X
IDOT-2073225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770651390OtherNPI NUMBER
WA7682594Medicaid
WA174764OtherLABOR & INDUSTRIES
DA9136OtherMEDICARE RAILROAD
9730RAOtherREGENCE NUMBER
9730RAOtherREGENCE NUMBER
4781680001Medicare NSC