Provider Demographics
NPI:1215385687
Name:MENDOZA, RACHEL LYNN (OTR)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6939 138TH ST
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1631
Mailing Address - Country:US
Mailing Address - Phone:347-523-0093
Mailing Address - Fax:
Practice Address - Street 1:6939 138TH ST
Practice Address - Street 2:
Practice Address - City:KEW GARDENS HILLS
Practice Address - State:NY
Practice Address - Zip Code:11367-1631
Practice Address - Country:US
Practice Address - Phone:347-523-0093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020571-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist