Provider Demographics
NPI:1669907382
Name:MITCHELL, RACHEL (COTA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11936 198TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3728
Mailing Address - Country:US
Mailing Address - Phone:718-908-2143
Mailing Address - Fax:718-723-5834
Practice Address - Street 1:11936 198TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3728
Practice Address - Country:US
Practice Address - Phone:718-908-2143
Practice Address - Fax:718-723-5834
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008201-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant