Provider Demographics
NPI:1518529833
Name:SIEGEL-BERELE, RACHAEL AMY
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:AMY
Last Name:SIEGEL-BERELE
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 1:236 GANNETT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6913
Mailing Address - Country:US
Mailing Address - Phone:207-661-6703
Mailing Address - Fax:
Practice Address - Street 1:236 GANNETT DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6913
Practice Address - Country:US
Practice Address - Phone:207-661-6703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT7308225X00000X
MEOT3708225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist