Provider Demographics
NPI:1851808612
Name:OHLDE, RACHEL LEE (PTA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEE
Last Name:OHLDE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-2316
Mailing Address - Country:US
Mailing Address - Phone:360-229-0576
Mailing Address - Fax:
Practice Address - Street 1:1525 WILMINGTON DR STE 100
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-7722
Practice Address - Country:US
Practice Address - Phone:253-212-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160662023225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant