Provider Demographics
NPI:1730466731
Name:MOSHER, RACHEL (MT-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MOSHER
Suffix:
Gender:F
Credentials:MT-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-0633
Mailing Address - Country:US
Mailing Address - Phone:315-727-8396
Mailing Address - Fax:
Practice Address - Street 1:285 LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-3229
Practice Address - Country:US
Practice Address - Phone:315-727-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000974-1225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist