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General NPI Number Information
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NPI Number | 1487361069
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Entity Type | Individual
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Provider Name | RACHEL JOHANNSEN
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Gender | Female
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 66 NEWTON ST
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City | WALTHAM
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State | MA
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Zip | 02453-6058
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Country | US
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Telephone | 605-281-8073
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Fax |
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Provider Business Mailing Address
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Address Line | 34 WINSHIP ST UNIT B
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City | BRIGHTON
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State | MA
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Zip | 02135-3342
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Country | US
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Telephone | 605-281-0873
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 14517
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License Number State | MA
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