MEDICARE: MS. RACHELLE GAVINO OTR-L

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
1	225XP0200X	Pediatric Occupational Therapist	OT2947	CA

General Provider Information

NPI Number	:	1063532463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHELLE GAVINO OTR-L

Provider Business Mailing Address
First Line	:	1609 E MADISON AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-1046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 EAST MADISON AVE
Second Line	:	EL CAJON MEDICAL THERAPY UNIT
City	:	EL CAJON
State	:	CA
Zip	:	92019-0000
Country	:	US
Telephone Number	:	619-588-3169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	03/05/2010

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