Provider Demographics
NPI:1063694024
Name:RAYMOND, JENNIFER R (COTAL)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1549 GEORGIA AVENUE SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-735-1062
Mailing Address - Fax:509-737-8492
Practice Address - Street 1:1549 GEORGIA AVENUE SE
Practice Address - Street 2:SUITE A
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-735-1062
Practice Address - Fax:509-737-8492
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant