Provider Demographics
NPI:1578046397
Name:VISCONTI, RACHAEL FAITH (OTR/L)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:FAITH
Last Name:VISCONTI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3251
Mailing Address - Country:US
Mailing Address - Phone:413-374-4045
Mailing Address - Fax:
Practice Address - Street 1:585 OLD HOMESTEAD HWY
Practice Address - Street 2:
Practice Address - City:SWANZEY
Practice Address - State:NH
Practice Address - Zip Code:03446-2303
Practice Address - Country:US
Practice Address - Phone:603-352-4797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10236225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2817OtherALLIED HEALTH: OCCUPATIONAL THERAPIST LICENSE
MA10236OtherBOARD OF ALLIED HEALTH PROFESSIONALS: OT LICENSE