Provider Demographics
NPI:1457630733
Name:RASEFSKE, PAULA MARIE
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:RASEFSKE
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 1:1100 WINNIE WAY
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-9080
Mailing Address - Country:US
Mailing Address - Phone:724-875-5846
Mailing Address - Fax:
Practice Address - Street 1:1100 WINNIE WAY
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-9080
Practice Address - Country:US
Practice Address - Phone:724-875-5846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004761L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist