Provider Demographics
NPI:1841712163
Name:FUCILLO, RACHEL ELAINE (OTR/L)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELAINE
Last Name:FUCILLO
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 1:185 PETERSON PATH
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-4167
Mailing Address - Country:US
Mailing Address - Phone:781-424-1818
Mailing Address - Fax:
Practice Address - Street 1:308 KINGSTOWN WAY
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-4647
Practice Address - Country:US
Practice Address - Phone:781-585-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12313225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist