Provider Demographics
NPI:1760675235
Name:RACHKOVSKY, ELYSE D (MS, OTR)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:D
Last Name:RACHKOVSKY
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 BROKEN SOUND PKWY NW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2773
Mailing Address - Country:US
Mailing Address - Phone:561-367-1175
Mailing Address - Fax:561-367-0884
Practice Address - Street 1:5901 BROKEN SOUND PKWY NW
Practice Address - Street 2:SUITE 500
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2773
Practice Address - Country:US
Practice Address - Phone:561-367-1175
Practice Address - Fax:561-367-0884
Is Sole Proprietor?:No
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV085002171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor