Provider Demographics
NPI:1083119598
Name:PARK, RACHEL (OT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 CAPITAL MALL DR SW STE D
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8654
Mailing Address - Country:US
Mailing Address - Phone:360-709-6221
Mailing Address - Fax:360-359-4727
Practice Address - Street 1:3901 CAPITAL MALL DR SW STE D
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8654
Practice Address - Country:US
Practice Address - Phone:360-709-6221
Practice Address - Fax:360-359-4727
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X, 390200000X
WAOT61337466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program