Provider Demographics
NPI:1427426535
Name:ELLIOTT, RACHEL STARR (COTA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:STARR
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 LOMBARDY RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4213
Mailing Address - Country:US
Mailing Address - Phone:405-833-8723
Mailing Address - Fax:
Practice Address - Street 1:1120 LOMBARDY RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4213
Practice Address - Country:US
Practice Address - Phone:405-833-8723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1218251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health