Provider Demographics
NPI:1497094460
Name:CHAVEZ, RACQUEL SANTOS (OTR/L, CPAM, CKTP)
Entity Type:Individual
Prefix:
First Name:RACQUEL
Middle Name:SANTOS
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:OTR/L, CPAM, CKTP
Other - Prefix:
Other - First Name:RACQUEL
Other - Middle Name:SANTOS
Other - Last Name:ADIZAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:17803 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2362
Practice Address - Country:US
Practice Address - Phone:714-777-9666
Practice Address - Fax:714-223-5811
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT8200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist