Provider Demographics
NPI:1699124180
Name:DEROY, RACHEL CAROLYN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:CAROLYN
Last Name:DEROY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:CAROLYN
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:94-1390 KULEWA LOOP
Mailing Address - Street 2:#42/U
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4390
Mailing Address - Country:US
Mailing Address - Phone:601-218-7075
Mailing Address - Fax:
Practice Address - Street 1:94-1390 KULEWA LOOP
Practice Address - Street 2:#42/U
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4390
Practice Address - Country:US
Practice Address - Phone:601-218-7075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1547225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist