Provider Demographics
NPI:1063063923
Name:KING, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 ABERCROMBIE LN
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-7073
Mailing Address - Country:US
Mailing Address - Phone:941-321-6703
Mailing Address - Fax:888-810-8617
Practice Address - Street 1:1945 ABERCROMBIE LN
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-7073
Practice Address - Country:US
Practice Address - Phone:941-321-6703
Practice Address - Fax:888-810-8617
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT20063225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist