Provider Demographics
NPI:1689631921
Name:LEVINE, RACHEL LINDA (OTRIL CHT)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LINDA
Last Name:LEVINE
Suffix:
Gender:F
Credentials:OTRIL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 THERMOS AVENUE
Mailing Address - Street 2:UNIT 303
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-887-8511
Mailing Address - Fax:
Practice Address - Street 1:86 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-444-8713
Practice Address - Fax:860-444-1671
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2475225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist