Provider Demographics
NPI:1881314177
Name:PENNY, RACHEL (OTR/L)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PENNY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 N VERNAL AVE
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2104
Mailing Address - Country:US
Mailing Address - Phone:435-789-5683
Mailing Address - Fax:833-520-1531
Practice Address - Street 1:80 N VERNAL AVE
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2104
Practice Address - Country:US
Practice Address - Phone:435-789-5683
Practice Address - Fax:833-520-1531
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13002962-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1588238133Medicaid