Provider Demographics
NPI:1356604060
Name:KONG, RACHELLE CELESTE (OTR/L)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:CELESTE
Last Name:KONG
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 1:200 N END AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282-7001
Mailing Address - Country:US
Mailing Address - Phone:805-443-7622
Mailing Address - Fax:
Practice Address - Street 1:200 N END AVE APT 3L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10282
Practice Address - Country:US
Practice Address - Phone:805-443-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9483225X00000X
NY016793225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist