Provider Demographics
NPI:1164070207
Name:GAUGHENBAUGH, RACHEL ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:GAUGHENBAUGH
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 1:5228 WILLOWCREST AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3414
Mailing Address - Country:US
Mailing Address - Phone:304-670-6315
Mailing Address - Fax:
Practice Address - Street 1:10780 SANTA MONICA BLVD STE 405
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7655
Practice Address - Country:US
Practice Address - Phone:310-234-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0T20385225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics