Healthcare Provider Details

I. General information

NPI: 1629587068
Provider Name (Legal Business Name): RACHEL ELIZABETH KING OTR/L, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL ELIZABETH EAKIN OTR/L, MS

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 TESCONI CIR STE G
SANTA ROSA CA
95401-4611
US

IV. Provider business mailing address

320 TESCONI CIR SUITE G
SANTA ROSA CA
95401-4611
US

V. Phone/Fax

Practice location:
  • Phone: 707-544-2637
  • Fax: 707-544-2088
Mailing address:
  • Phone: 707-544-2637
  • Fax: 707-544-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT16281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: