Healthcare Provider Details

I. General information

NPI: 1346440930
Provider Name (Legal Business Name): JASON G RUZICKA CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16528 DESMET CT
SPOKANE VALLEY WA
99216-3522
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-944-8920
  • Fax: 509-227-7070
Mailing address:
  • Phone: 509-624-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT00003412
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: