Provider Demographics
NPI:1053890996
Name:RETHERFORD, JAMIE ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:RETHERFORD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16900 SE 26TH DR APT 67
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3487
Mailing Address - Country:US
Mailing Address - Phone:740-656-7212
Mailing Address - Fax:
Practice Address - Street 1:8716 E MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2531
Practice Address - Country:US
Practice Address - Phone:360-696-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60848303224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant