MEDICARE: RACHEL ANNE HERN OTD, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056.007677	IL

General Provider Information

NPI Number	:	1922182666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL ANNE HERN OTD, OTR/L

Provider Business Mailing Address
First Line	:	2325 RALPH BOONE
Second Line	:
City	:	CLOVIS
State	:	NM
Zip	:	88101-9018
Country	:	US
Telephone Number	:	847-331-0804
Fax Number	:

Provider Business Practice Location Address
First Line	:	1754 W WILSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4515
Country	:	US
Telephone Number	:	773-878-7868
Fax Number	:	773-878-7869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	03/19/2021

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