Basic Information
| Provider Information | |||||||||
| NPI: | 1770651390 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RATTRAY | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | OTR L, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11009 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985081009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099621132 | ||||||||
| FaxNumber: | 8663655203 | ||||||||
| Practice Location | |||||||||
| Address1: | 1205 HIGHWAY 2 STE 102 | ||||||||
| Address2: | |||||||||
| City: | SANDPOINT | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838642740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003535208 | ||||||||
| FaxNumber: | 8663655203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | OT00003293 | WA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225X00000X | OT-2073 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1770651390 | 01 | NPI NUMBER | OTHER | 7682594 | 05 | WA | MEDICAID | 174764 | 01 | WA | LABOR & INDUSTRIES | OTHER | DA9136 | 01 | MEDICARE RAILROAD | OTHER | 9730RA | 01 | REGENCE NUMBER | OTHER |