Provider Demographics
NPI:1760840144
Name:PLACE, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PLACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 AMSTERDAM AVE
Mailing Address - Street 2:APT #15D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6907
Mailing Address - Country:US
Mailing Address - Phone:917-921-5983
Mailing Address - Fax:
Practice Address - Street 1:34 W 118TH ST
Practice Address - Street 2:#101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1937
Practice Address - Country:US
Practice Address - Phone:917-921-5983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020163-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist