Provider Demographics
NPI:1043643505
Name:OTTUM, RACHAEL L (DPT)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:L
Last Name:OTTUM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:L
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1015 SIBLEY MEMORIAL HWY APT 232
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-5601
Mailing Address - Country:US
Mailing Address - Phone:651-492-1293
Mailing Address - Fax:
Practice Address - Street 1:1015 SIBLEY MEMORIAL HWY APT 232
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-5601
Practice Address - Country:US
Practice Address - Phone:651-492-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist