Provider Demographics
NPI:1003583378
Name:ROSE, RACHEL (OTD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-2117
Mailing Address - Country:US
Mailing Address - Phone:815-404-0574
Mailing Address - Fax:
Practice Address - Street 1:10 W PHILLIP RD STE 108
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1730
Practice Address - Country:US
Practice Address - Phone:847-231-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics