Provider Demographics
NPI:1679186399
Name:MAHON, RACHEL GRACE
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:GRACE
Last Name:MAHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 S 48TH ST STE 145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-9138
Mailing Address - Country:US
Mailing Address - Phone:480-508-7566
Mailing Address - Fax:928-212-9014
Practice Address - Street 1:15215 S 48TH ST STE 145
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9138
Practice Address - Country:US
Practice Address - Phone:480-508-7566
Practice Address - Fax:928-212-9014
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ008246225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist