Provider Demographics
NPI:1245448562
Name:POULIN, RACHEL B (OTR-L)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:B
Last Name:POULIN
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 STAGECOACH LN
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1164
Mailing Address - Country:US
Mailing Address - Phone:860-571-0036
Mailing Address - Fax:
Practice Address - Street 1:245 LONG HILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4063
Practice Address - Country:US
Practice Address - Phone:860-704-8400
Practice Address - Fax:860-343-8166
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002248225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist