Provider Demographics
NPI:1801258223
Name:RUCH, JESSICA (COTA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RUCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CEMETERY ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-3011
Mailing Address - Country:US
Mailing Address - Phone:603-348-0567
Mailing Address - Fax:
Practice Address - Street 1:3452 LAKE LYNDA DR. SUITE 200
Practice Address - Street 2:JACKSON THERAPY PARTNERS
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817
Practice Address - Country:US
Practice Address - Phone:407-308-3918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH349360224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant