Provider Demographics
NPI:1437938230
Name:TAYOUBI IDRISSI, RACHID I
Entity Type:Individual
Prefix:MR
First Name:RACHID
Middle Name:
Last Name:TAYOUBI IDRISSI
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 IONE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6669
Mailing Address - Country:US
Mailing Address - Phone:203-715-1221
Mailing Address - Fax:
Practice Address - Street 1:103 IONE DR
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6669
Practice Address - Country:US
Practice Address - Phone:203-715-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027625975224ZR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantDriving and Community Mobility