Provider Demographics
NPI:1407395072
Name:BROGLE, RACHEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BROGLE
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 1:1025 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4039
Mailing Address - Country:US
Mailing Address - Phone:970-348-6105
Mailing Address - Fax:
Practice Address - Street 1:1025 9TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4039
Practice Address - Country:US
Practice Address - Phone:970-348-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021167-1225X00000X
COOT.0005639225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist