Healthcare Provider Details

I. General information

NPI: 1548706062
Provider Name (Legal Business Name): RACHEL FROMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2017
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date: 05/25/2020
Reactivation Date: 06/09/2020

III. Provider practice location address

7228 CARMEL CT
BOCA RATON FL
33433-5544
US

IV. Provider business mailing address

7228 CARMEL CT
BOCA RATON FL
33433-5544
US

V. Phone/Fax

Practice location:
  • Phone: 347-496-2454
  • Fax:
Mailing address:
  • Phone: 347-496-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: