Provider Demographics
NPI:1407358245
Name:MATSOUKAS, RACHEL ANNA
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNA
Last Name:MATSOUKAS
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 1:3000 YOUNGFIELD ST STE 163
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80215-6550
Mailing Address - Country:US
Mailing Address - Phone:303-233-9700
Mailing Address - Fax:303-233-2806
Practice Address - Street 1:3000 YOUNGFIELD ST STE 163
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80215-6550
Practice Address - Country:US
Practice Address - Phone:303-233-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005312225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist