Provider Demographics
NPI:1306111844
Name:OSTRANDERGRECO, RACHAEL (LMT)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:
Last Name:OSTRANDERGRECO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 MANNYS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7306
Mailing Address - Country:US
Mailing Address - Phone:518-224-8019
Mailing Address - Fax:
Practice Address - Street 1:349 MANNYS CORNERS RD
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7306
Practice Address - Country:US
Practice Address - Phone:518-224-8019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022012225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist