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NPI Code Detail

MEDICARE: RACHEL ANN GAUGHENBAUGH OTR/L

MEDICARE: RACHEL ANN GAUGHENBAUGH 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
1225XP0200XPediatric Occupational Therapist0T20385CA

General Provider Information

NPI Number : 1164070207
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL ANN GAUGHENBAUGH OTR/L
Provider Business Mailing Address
First Line : 5228 WILLOWCREST AVE UNIT 1
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91601-3414
Country : US
Telephone Number : 304-670-6315
Fax Number :
Provider Business Practice Location Address
First Line : 10780 SANTA MONICA BLVD STE 405
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-7655
Country : US
Telephone Number : 310-234-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2019
Last Update Date : 09/02/2019

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