MEDICARE: MRS. RACHEL NICOLE OTTLEY 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	225X00000X	Occupational Therapist	1472	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4519052	OTHER	OK	AETNA
2	731300892004	OTHER	OK	BCBS OK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134349921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL NICOLE OTTLEY OTR/L

Provider Business Mailing Address
First Line	:	5813 E 98TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-5017
Country	:	US
Telephone Number	:	918-518-6588
Fax Number	:

Provider Business Practice Location Address
First Line	:	2257 W WASHINGTON ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-6703
Country	:	US
Telephone Number	:	918-994-7799
Fax Number	:

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/12/2019

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