Basic Information
| Provider Information | |||||||||
| NPI: | 1407490121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOSLEY | ||||||||
| FirstName: | RACHEL | ||||||||
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| Credential: | MSOT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 TILLERMAN CT | ||||||||
| Address2: | |||||||||
| City: | HAMPSTEAD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210742561 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3332 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211021952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102397139 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2019 | ||||||||
| LastUpdateDate: | 11/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 08698 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.