Provider Demographics
NPI:1477807394
Name:CANTRELL, RACHEL (COTA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:REMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47977-0415
Mailing Address - Country:US
Mailing Address - Phone:765-532-6645
Mailing Address - Fax:
Practice Address - Street 1:150 FENCL LN
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-2041
Practice Address - Country:US
Practice Address - Phone:708-449-9400
Practice Address - Fax:708-449-9700
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000149A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant