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General NPI Number Information
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NPI Number | 1063532463
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Entity Type | Individual
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Provider Name | RACHELLE GAVINO OTR-L
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 03/05/2010
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Provider Practice Location Address
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Address Line | 1609 EAST MADISON AVE EL CAJON MEDICAL THERAPY UNIT
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City | EL CAJON
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State | CA
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Zip | 92019-0000
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Country | US
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Telephone | 619-588-3169
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Fax |
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Provider Business Mailing Address
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Address Line | 1609 E MADISON AVE
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City | EL CAJON
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State | CA
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Zip | 92019-1046
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT2947
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License Number State | CA
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