Healthcare Provider Details

I. General information

NPI: 1942957279
Provider Name (Legal Business Name): RACHEL LAUREN HENNESSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17301 S IH 35 STE 101
BUDA TX
78610-5250
US

IV. Provider business mailing address

11700 DIONDA LN APT 3308
DEL VALLE TX
78617-2621
US

V. Phone/Fax

Practice location:
  • Phone: 512-994-4115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: