Provider Demographics
NPI:1730440124
Name:MANA, RACHEL L (COTA/L)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:MANA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:L
Other - Last Name:HAUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4951 BACARDI LN
Mailing Address - Street 2:APT B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1334
Mailing Address - Country:US
Mailing Address - Phone:314-471-2997
Mailing Address - Fax:
Practice Address - Street 1:4335 W PINE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2205
Practice Address - Country:US
Practice Address - Phone:314-615-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-02
Last Update Date:2012-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011004638224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant