Provider Demographics
NPI:1861059057
Name:RIVARD, RACHEL REBECCA (OTR/L)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:REBECCA
Last Name:RIVARD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:REBECCA
Other - Last Name:WEIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2925 BUCKLEY WAY
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-2018
Mailing Address - Country:US
Mailing Address - Phone:612-273-4155
Mailing Address - Fax:
Practice Address - Street 1:2925 BUCKLEY WAY
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-2018
Practice Address - Country:US
Practice Address - Phone:651-455-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105663225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN105663OtherMINNESOTA OCCUPATIONAL THERAPY INDIVIDUAL LICENSE NUMBER