Provider Demographics
NPI:1720672470
Name:RAKOWSKI, CORRIN MICHELLE (MS, CTRS)
Entity Type:Individual
Prefix:
First Name:CORRIN
Middle Name:MICHELLE
Last Name:RAKOWSKI
Suffix:
Gender:F
Credentials:MS, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 WAUNETA ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4400
Mailing Address - Country:US
Mailing Address - Phone:805-405-3278
Mailing Address - Fax:
Practice Address - Street 1:3020 WAUNETA ST
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-4400
Practice Address - Country:US
Practice Address - Phone:805-405-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82214225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist