MEDICARE: RACHEL PINKERTON SEQUEIRA OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	63011090	NY

General Provider Information

NPI Number	:	1134494099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL PINKERTON SEQUEIRA OT

Provider Business Mailing Address
First Line	:	4862 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-3136
Country	:	US
Telephone Number	:	212-544-8021
Fax Number	:

Provider Business Practice Location Address
First Line	:	4862 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-3136
Country	:	US
Telephone Number	:	212-544-8021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2012
Last Update Date	:	03/12/2012

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