Provider Demographics
NPI:1063399459
Name:RISNER, RACHEL KATHRYN (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:KATHRYN
Last Name:RISNER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:KATHYRN
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:342 BRADY RD
Mailing Address - Street 2:
Mailing Address - City:SACKETS HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:13685-9504
Mailing Address - Country:US
Mailing Address - Phone:419-618-7602
Mailing Address - Fax:
Practice Address - Street 1:159 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2045
Practice Address - Country:US
Practice Address - Phone:315-342-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011728-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant