1760953616 NPI number — RACHEL A MCCALL III OTR/L

Table of content: RACHEL A MCCALL III OTR/L (NPI 1760953616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760953616 NPI number — RACHEL A MCCALL III OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCALL
Provider First Name:
RACHEL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
III
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760953616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1557 SOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEWATER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02324-3522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-444-7028
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 CHIPMAN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02364-1039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-585-4100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2018

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:  12642 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

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




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