Provider Demographics
NPI:1174903744
Name:RACHO, MARIVIC LO (OT)
Entity type:Individual
Prefix:
First Name:MARIVIC
Middle Name:LO
Last Name:RACHO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4027 CHESSA LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-5124
Mailing Address - Country:US
Mailing Address - Phone:559-326-7365
Mailing Address - Fax:559-326-7365
Practice Address - Street 1:4027 CHESSA LN
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-5124
Practice Address - Country:US
Practice Address - Phone:559-326-7365
Practice Address - Fax:559-326-7365
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10202225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist