Provider Demographics
NPI:1689225914
Name:RAKITA, ILANA (COTA/L)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:RAKITA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ILANA
Other - Middle Name:
Other - Last Name:RAKITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:2520 N MCMULLEN BOOTH RD STE B208
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4181
Mailing Address - Country:US
Mailing Address - Phone:727-503-6482
Mailing Address - Fax:
Practice Address - Street 1:111 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-1388
Practice Address - Country:US
Practice Address - Phone:304-462-5718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC2289224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant