Provider Demographics
NPI:1134349921
Name:OTTLEY, RACHEL NICOLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:NICOLE
Last Name:OTTLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5813 E 98TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-5017
Mailing Address - Country:US
Mailing Address - Phone:918-518-6588
Mailing Address - Fax:
Practice Address - Street 1:2257 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-6703
Practice Address - Country:US
Practice Address - Phone:918-994-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1472225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4519052OtherAETNA
OK731300892004OtherBCBS OK
OK100675110DMedicaid