Provider Demographics
NPI:1588021802
Name:OCAMPO, RACHIELA PANGAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:RACHIELA
Middle Name:PANGAN
Last Name:OCAMPO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RACHIELA
Other - Middle Name:
Other - Last Name:OCAMPO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:905 HAMILTON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2668
Mailing Address - Country:US
Mailing Address - Phone:863-409-3735
Mailing Address - Fax:888-847-0781
Practice Address - Street 1:905 HAMILTON PLACE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2668
Practice Address - Country:US
Practice Address - Phone:863-409-3735
Practice Address - Fax:888-847-0781
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-17
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist