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General NPI Number Information
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NPI Number | 1770651390
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Entity Type | Individual
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Provider Name | JARED R RATTRAY OTR L, CHT
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Gender | Male
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 1205 HIGHWAY 2 STE 102
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City | SANDPOINT
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State | ID
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Zip | 83864-2740
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Country | US
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Telephone | 800-353-5208
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Fax | 866-365-5203
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Provider Business Mailing Address
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Address Line | PO BOX 11009
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City | OLYMPIA
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State | WA
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Zip | 98508-1009
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Country | US
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Telephone | 509-962-1132
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Fax | 866-365-5203
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | OT00003293
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-2073
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License Number State | ID
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