MEDICARE: RACHEL OT PC

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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1992101398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RACHEL OT PC

Provider Business Mailing Address
First Line	:	111 CLIFTON AVE STE 3
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3342
Country	:	US
Telephone Number	:	732-399-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1731 61ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2219
Country	:	US
Telephone Number	:	718-236-4268
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RACHEL LERNER
Credential	:
Telephone Number	:	718-236-4268

Provider Enumeration Date	:	11/12/2014
Last Update Date	:	01/22/2018

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