MEDICARE: JENNY REHORST OTRL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0348	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0348	OTHER	SD	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1871770966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY REHORST OTRL

Provider Business Mailing Address
First Line	:	7110 JORDAN DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7110 JORDAN DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8738
Country	:	US
Telephone Number	:	605-342-4412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	01/30/2008

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Directions to “ JENNY REHORST OTRL” Practice Location

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