Provider Demographics
NPI:1679539555
Name:RACETTE, GERALDINE I (OTR)
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:I
Last Name:RACETTE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ISOBELLA
Other - Middle Name:G
Other - Last Name:LARKIN RACETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1119
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02901-1119
Mailing Address - Country:US
Mailing Address - Phone:401-457-1580
Mailing Address - Fax:401-831-0500
Practice Address - Street 1:1598 S COUNTY TRL STE 100
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1627
Practice Address - Country:US
Practice Address - Phone:401-884-1177
Practice Address - Fax:401-884-8697
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT00725225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI679004631Medicare ID - Type Unspecified
007059778Medicare PIN