1659459584 NPI number — MRS. RACHEL ELIZABETH VITELLO OTR/L

Table of content: MRS. RACHEL ELIZABETH VITELLO OTR/L (NPI 1659459584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659459584 NPI number — MRS. RACHEL ELIZABETH VITELLO OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VITELLO
Provider First Name:
RACHEL
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
RACHEL
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659459584
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 NORWICH NEW LONDON TURNPIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNCASVILLE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-848-9157
Provider Business Mailing Address Fax Number:
860-848-3471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 NORWICH NEW LONDON TURNPIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNCASVILLE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-848-9157
Provider Business Practice Location Address Fax Number:
860-848-3471
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT01042 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 003099 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11902023 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".