Provider Demographics
NPI:1518570258
Name:KAKURIEV, RACHEL T (OTR/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:T
Last Name:KAKURIEV
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 BAY 32ND ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1848
Mailing Address - Country:US
Mailing Address - Phone:516-406-4202
Mailing Address - Fax:
Practice Address - Street 1:1057 BAY 32ND ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1848
Practice Address - Country:US
Practice Address - Phone:516-406-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024551225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics