Healthcare Provider Details

I. General information

NPI: 1407731995
Provider Name (Legal Business Name): RACHAEL RENEE REPETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 LOUISE UNDERWOOD WAY
LOUISVILLE KY
40216-3987
US

IV. Provider business mailing address

2311 GRANGER RD
FAIRDALE KY
40118-9724
US

V. Phone/Fax

Practice location:
  • Phone: 502-368-2348
  • Fax:
Mailing address:
  • Phone: 331-245-7612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number301405
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: