Provider Demographics
NPI:1265271084
Name:RACZKOWSKI, HADASA (OTR/L)
Entity type:Individual
Prefix:
First Name:HADASA
Middle Name:
Last Name:RACZKOWSKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:HADASA
Other - Middle Name:
Other - Last Name:PACHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14451 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2412
Mailing Address - Country:US
Mailing Address - Phone:347-497-0579
Mailing Address - Fax:
Practice Address - Street 1:14451 73RD AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2412
Practice Address - Country:US
Practice Address - Phone:347-497-0579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029163225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist