Provider Demographics
NPI:1982886545
Name:FRASER, RACHEL (OT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:FRASER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ELM ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3669
Mailing Address - Country:US
Mailing Address - Phone:860-741-2242
Mailing Address - Fax:860-741-2248
Practice Address - Street 1:7 ELM ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3669
Practice Address - Country:US
Practice Address - Phone:860-741-2242
Practice Address - Fax:860-741-2248
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000955225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT076572OtherMEDICARE GROUP ID