Provider Demographics
NPI:1750762746
Name:LAWRENCE, RACHEL R (OTR)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:R
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:R
Other - Last Name:KEINATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N18W6341 CARRIAGE TRCE
Mailing Address - Street 2:APT 151
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2767
Mailing Address - Country:US
Mailing Address - Phone:989-529-1149
Mailing Address - Fax:
Practice Address - Street 1:N18W6341 CARRIAGE TRCE
Practice Address - Street 2:APT 151
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2767
Practice Address - Country:US
Practice Address - Phone:989-529-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5634-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist