Healthcare Provider Details

I. General information

NPI: 1144057084
Provider Name (Legal Business Name): RACHEL VICTORIA VAKNINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 FAIRLAND RD
SILVER SPRING MD
20904-5427
US

IV. Provider business mailing address

206 WINDSOR DR
SYRACUSE NY
13214-1634
US

V. Phone/Fax

Practice location:
  • Phone: 301-384-6161
  • Fax:
Mailing address:
  • Phone: 315-329-1782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number029464
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10731
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: