Provider Demographics
NPI:1568581288
Name:ROBERTS, RACHEL GASTALA (OTR)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:GASTALA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:IBANEZ
Other - Last Name:GASTALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8202 E MONTECITO AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2719
Mailing Address - Country:US
Mailing Address - Phone:602-791-0451
Mailing Address - Fax:
Practice Address - Street 1:1 N MACDONALD
Practice Address - Street 2:SUITE 212
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7339
Practice Address - Country:US
Practice Address - Phone:480-668-1917
Practice Address - Fax:480-668-2750
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2615225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics