Provider Demographics
NPI:1740998269
Name:COY, RACHAEL ELISE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:ELISE
Last Name:COY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:RACHAEL
Other - Middle Name:ELISE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:240 MODOC PL
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3124
Mailing Address - Country:US
Mailing Address - Phone:650-580-9300
Mailing Address - Fax:
Practice Address - Street 1:2280 GELLERT BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5411
Practice Address - Country:US
Practice Address - Phone:650-242-4154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16615225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist