Provider Demographics
NPI:1043054281
Name:OTEY, RACHAEL (CNA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:OTEY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 JIMMY ANN DR APT 1914
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1357
Mailing Address - Country:US
Mailing Address - Phone:386-301-8929
Mailing Address - Fax:
Practice Address - Street 1:600 JIMMY ANN DR APT 1914
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1357
Practice Address - Country:US
Practice Address - Phone:386-301-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL449783376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide