Provider Demographics
NPI:1013639491
Name:ALLERT, RACHAEL ANN (LCOTA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANN
Last Name:ALLERT
Suffix:
Gender:F
Credentials:LCOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 OLD HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:LA
Mailing Address - Zip Code:71336-5850
Mailing Address - Country:US
Mailing Address - Phone:318-439-0383
Mailing Address - Fax:
Practice Address - Street 1:112 FAIR AVE
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-2116
Practice Address - Country:US
Practice Address - Phone:318-460-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5807224Z00000X
LA333430224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant