Provider Demographics
NPI:1831911544
Name:RAKOCHY, JENNIFER ANDREA (OTR)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANDREA
Last Name:RAKOCHY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:RAKOCHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:570 WESTMINSTER RD APT B22
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1446
Mailing Address - Country:US
Mailing Address - Phone:917-519-5892
Mailing Address - Fax:
Practice Address - Street 1:1651 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5849
Practice Address - Country:US
Practice Address - Phone:718-998-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist