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NPI Code Detail

MEDICARE: RACHELLE R CLARK OT

MEDICARE: RACHELLE R CLARK OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist1283GA

General Provider Information

NPI Number : 1003818279
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHELLE R CLARK OT
Provider Business Mailing Address
First Line : 2367 GA HIGHWAY 88
Second Line :
City : HEPHZIBAH
State : GA
Zip : 30815-4630
Country : US
Telephone Number : 706-592-5565
Fax Number :
Provider Business Practice Location Address
First Line : 2367 GA HIGHWAY 88
Second Line :
City : HEPHZIBAH
State : GA
Zip : 30815-4630
Country : US
Telephone Number : 706-592-5565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 07/08/2007

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