Provider Demographics
NPI:1922182666
Name:HERN, RACHEL ANNE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
Last Name:HERN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 RALPH BOONE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-9018
Mailing Address - Country:US
Mailing Address - Phone:847-331-0804
Mailing Address - Fax:
Practice Address - Street 1:1754 W WILSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4515
Practice Address - Country:US
Practice Address - Phone:773-878-7868
Practice Address - Fax:773-878-7869
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.007677225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist