1629228598 NPI number — MRS. ANDREA JAYNE RAPSON O.T.

Table of content: MRS. ANDREA JAYNE RAPSON O.T. (NPI 1629228598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629228598 NPI number — MRS. ANDREA JAYNE RAPSON O.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAPSON
Provider First Name:
ANDREA
Provider Middle Name:
JAYNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEUTZINGER
Provider Other First Name:
ANDREA
Provider Other Middle Name:
JAYNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629228598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 876104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASILLA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99687-6104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-982-3897
Provider Business Mailing Address Fax Number:
866-283-2986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 S. KGB
Provider Second Line Business Practice Location Address:
SUITE G,H
Provider Business Practice Location Address City Name:
WASILLA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-982-3897
Provider Business Practice Location Address Fax Number:
866-283-2986
Provider Enumeration Date:
09/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  2195 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OT0031 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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