Provider Demographics
NPI:1245700038
Name:MARTIN, RACHAEL (OTR/L)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:MARTIN
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 1:1467 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:HARVEYS LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:18618-3114
Mailing Address - Country:US
Mailing Address - Phone:201-248-4620
Mailing Address - Fax:
Practice Address - Street 1:1467 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:HARVEYS LAKE
Practice Address - State:PA
Practice Address - Zip Code:18618-3114
Practice Address - Country:US
Practice Address - Phone:201-248-4620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023114-1225X00000X
PAOC019255225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist