Provider Demographics
NPI:1700193257
Name:NELSON, RACHEL A (MOTR/L, BS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:MOTR/L, BS
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:A
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L, BS
Mailing Address - Street 1:317 VASSAR DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2826
Mailing Address - Country:US
Mailing Address - Phone:505-690-3229
Mailing Address - Fax:
Practice Address - Street 1:1316 JACKIE RD SE STE 900
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6612
Practice Address - Country:US
Practice Address - Phone:505-289-1042
Practice Address - Fax:505-466-5895
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X
NM3344225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28657233Medicaid