Provider Demographics
NPI:1205167806
Name:RAKERS, MARIA THERESA
Entity type:Individual
Prefix:
First Name:MARIA THERESA
Middle Name:
Last Name:RAKERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA THERESA
Other - Middle Name:
Other - Last Name:TALUSAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5735 163RD ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1438
Mailing Address - Country:US
Mailing Address - Phone:646-831-2189
Mailing Address - Fax:
Practice Address - Street 1:4915 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3301
Practice Address - Country:US
Practice Address - Phone:347-394-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014774225X00000X
AZOTH-006039225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist