=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245742600
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL MARIT FOWLER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2017
-----------------------------------------------------
Last Update Date | 08/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 236 BURTS RD
-----------------------------------------------------
City | KIRKWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-426-3307
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 HELEN ST
-----------------------------------------------------
City | BINGHAMTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13905-3960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-955-9335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------