Provider Demographics
NPI:1700156668
Name:DERUS, RACHEL MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:DERUS
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 1:15636 WINDMILL POINT RD
Mailing Address - Street 2:
Mailing Address - City:HUNTSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44046-8766
Mailing Address - Country:US
Mailing Address - Phone:216-906-1025
Mailing Address - Fax:
Practice Address - Street 1:4829 41ST ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-1707
Practice Address - Country:US
Practice Address - Phone:216-906-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000970224Z00000X
OH04381224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant