Provider Demographics
NPI:1073024048
Name:KOBAYASHI, RACHEL ELLEN
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELLEN
Last Name:KOBAYASHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5726
Mailing Address - Country:US
Mailing Address - Phone:217-622-1134
Mailing Address - Fax:
Practice Address - Street 1:3200 MISSION ARCH DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-8307
Practice Address - Country:US
Practice Address - Phone:575-624-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist