Provider Demographics
NPI:1316522907
Name:PORCARO, RACHEL RACINE (OTR)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:RACINE
Last Name:PORCARO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:RACINE
Other - Last Name:MALOUF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4419 ASHLAWN DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-5655
Mailing Address - Country:US
Mailing Address - Phone:810-908-8020
Mailing Address - Fax:
Practice Address - Street 1:4800 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2677
Practice Address - Country:US
Practice Address - Phone:810-275-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011068225X00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist