Provider Demographics
NPI:1043879430
Name:BLACKWELL, RACHEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:PALL MALL
Mailing Address - State:TN
Mailing Address - Zip Code:38577-4215
Mailing Address - Country:US
Mailing Address - Phone:931-265-8773
Mailing Address - Fax:
Practice Address - Street 1:1750 PARKER RD
Practice Address - Street 2:
Practice Address - City:PALL MALL
Practice Address - State:TN
Practice Address - Zip Code:38577
Practice Address - Country:US
Practice Address - Phone:606-224-6915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5043225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist