Provider Demographics
NPI:1790409530
Name:HOLT, RACHEL ROSE (COTA/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ROSE
Last Name:HOLT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W 10TH PL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3108
Mailing Address - Country:US
Mailing Address - Phone:602-741-3882
Mailing Address - Fax:
Practice Address - Street 1:1120 W 10TH PL
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3108
Practice Address - Country:US
Practice Address - Phone:602-741-3882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ000004602174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist