Provider Demographics
NPI:1316573744
Name:DAMIAN, RACHEL (COTA/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:DAMIAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 RUBERTA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2793
Mailing Address - Country:US
Mailing Address - Phone:323-202-5977
Mailing Address - Fax:
Practice Address - Street 1:221 E GLENOAKS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-2089
Practice Address - Country:US
Practice Address - Phone:818-881-0001
Practice Address - Fax:818-858-0068
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA3934224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty