Provider Demographics
NPI:1841668985
Name:CROSSIN, RACHAEL (COTA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:CROSSIN
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 1:215 TEWKSBURY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-3205
Mailing Address - Country:US
Mailing Address - Phone:215-932-8189
Mailing Address - Fax:
Practice Address - Street 1:215 TEWKSBURY RD
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-3205
Practice Address - Country:US
Practice Address - Phone:215-932-8189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09106200172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker