Provider Demographics
NPI:1114532553
Name:MASTERS, RACHAEL (COTA/L)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:MASTERS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:SEWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1572 GRAVEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:AR
Mailing Address - Zip Code:72837-7857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 N FULTON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3020
Practice Address - Country:US
Practice Address - Phone:833-241-2847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1449224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant