Provider Demographics
NPI:1750675567
Name:TIMMONS, RACHEL JORDAN (OTD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:JORDAN
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E. FIRMIN STREET
Mailing Address - Street 2:SUITE 209
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2375
Mailing Address - Country:US
Mailing Address - Phone:765-454-9748
Mailing Address - Fax:765-450-6664
Practice Address - Street 1:1320 W SPENCER AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3415
Practice Address - Country:US
Practice Address - Phone:765-662-0490
Practice Address - Fax:765-662-0853
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005169A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN31005169AOtherOCCUPATIONAL THERAPY LICENSE