Healthcare Provider Details

I. General information

NPI: 1700493277
Provider Name (Legal Business Name): RACHEL ELIZABETH PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 CORNERSTONE CT W STE 300
SAN DIEGO CA
92121-3772
US

IV. Provider business mailing address

1196 FAWN CIR
MANTENO IL
60950-3759
US

V. Phone/Fax

Practice location:
  • Phone: 866-687-7390
  • Fax:
Mailing address:
  • Phone: 815-954-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.017.000
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: