Healthcare Provider Details

I. General information

NPI: 1760675235
Provider Name (Legal Business Name): ELYSE D RACHKOVSKY MS, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2007
Last Update Date: 08/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROKEN SOUND PKWY NW SUITE 500
BOCA RATON FL
33487-2773
US

IV. Provider business mailing address

5901 BROKEN SOUND PKWY NW SUITE 500
BOCA RATON FL
33487-2773
US

V. Phone/Fax

Practice location:
  • Phone: 561-367-1175
  • Fax: 561-367-0884
Mailing address:
  • Phone: 561-367-1175
  • Fax: 561-367-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number085002
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: