Provider Demographics
NPI:1225500655
Name:THOMPSON, RACHELLE M
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76-49 HEWLETT STREET
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-728-3780
Mailing Address - Fax:
Practice Address - Street 1:10245 62ND RD APT 2S
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1017
Practice Address - Country:US
Practice Address - Phone:516-728-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-25
Last Update Date:2023-02-17
Deactivation Date:2018-12-28
Deactivation Code:
Reactivation Date:2019-01-11
Provider Licenses
StateLicense IDTaxonomies
NY009964-1224Z00000X
NY027702225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant