Provider Demographics
NPI:1861796716
Name:JALLES, RACHEL BLANCHETTE
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:BLANCHETTE
Last Name:JALLES
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 1:437 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MA
Mailing Address - Zip Code:02322-1509
Mailing Address - Country:US
Mailing Address - Phone:508-269-0499
Mailing Address - Fax:
Practice Address - Street 1:437 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:MA
Practice Address - Zip Code:02322-1509
Practice Address - Country:US
Practice Address - Phone:508-269-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11626225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist