Provider Demographics
NPI:1437731551
Name:BODEK, RACHEL (MST, TVI)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:BODEK
Suffix:
Gender:F
Credentials:MST, TVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4301
Mailing Address - Country:US
Mailing Address - Phone:845-426-3031
Mailing Address - Fax:
Practice Address - Street 1:177 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5091
Practice Address - Country:US
Practice Address - Phone:718-963-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3832866225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision