MEDICARE: RACHEL LYNN MENDOZA OTR

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	020571-1	NY

General Provider Information

NPI Number	:	1215385687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL LYNN MENDOZA OTR

Provider Business Mailing Address
First Line	:	6939 138TH ST
Second Line	:
City	:	KEW GARDENS HILLS
State	:	NY
Zip	:	11367-1631
Country	:	US
Telephone Number	:	347-523-0093
Fax Number	:

Provider Business Practice Location Address
First Line	:	6939 138TH ST
Second Line	:
City	:	KEW GARDENS HILLS
State	:	NY
Zip	:	11367-1631
Country	:	US
Telephone Number	:	347-523-0093
Fax Number	:

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

Provider Enumeration Date	:	05/26/2016
Last Update Date	:	05/26/2016

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