Healthcare Provider Details

I. General information

NPI: 1497379366
Provider Name (Legal Business Name): RACHEL REDFERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18115 N US HIGHWAY 41 STE 800
LUTZ FL
33549-6475
US

IV. Provider business mailing address

18926 PEBBLE LINKS CIR
TAMPA FL
33647-1899
US

V. Phone/Fax

Practice location:
  • Phone: 813-389-5301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ9823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: