Provider Demographics
NPI:1831138437
Name:SOMMER, RACQUEL (OT)
Entity Type:Individual
Prefix:
First Name:RACQUEL
Middle Name:
Last Name:SOMMER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9535
Mailing Address - Country:US
Mailing Address - Phone:941-918-9575
Mailing Address - Fax:941-346-9646
Practice Address - Street 1:1076 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9535
Practice Address - Country:US
Practice Address - Phone:941-918-9575
Practice Address - Fax:941-346-9646
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10467225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6575AMedicare ID - Type Unspecified