Healthcare Provider Details

I. General information

NPI: 1396232013
Provider Name (Legal Business Name): RACHEL SOVINE MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 COLLEGE ST # 1
JACKSONVILLE FL
32205-5318
US

IV. Provider business mailing address

7651 GATE PKWY APT 2002
JACKSONVILLE FL
32256-4820
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-0370
  • Fax:
Mailing address:
  • Phone: 954-608-1013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT19120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: