Provider Demographics
NPI:1578716130
Name:HODGE, RACHEL MARIE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MARIE
Last Name:HODGE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4488 WALTHAM DR
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9589
Mailing Address - Country:US
Mailing Address - Phone:315-256-7002
Mailing Address - Fax:315-682-0379
Practice Address - Street 1:4488 WALTHAM DR
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9589
Practice Address - Country:US
Practice Address - Phone:315-256-7002
Practice Address - Fax:315-682-0379
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006353-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant