Basic Information
Provider Information
NPI: 1386834034
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RATAJCZAK
FirstName: RHONDA
MiddleName: LYNNE
NamePrefix: MS.
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4 LONGFELLOW PL
Address2: APT 2405
City: BOSTON
State: MA
PostalCode: 021142838
CountryCode: US
TelephoneNumber: 9196732328
FaxNumber:  
Practice Location
Address1: 15 PARKMAN ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021143117
CountryCode: US
TelephoneNumber: 6177240125
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/30/2007
LastUpdateDate: 07/30/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X9377MAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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