Provider Demographics
NPI:1003377789
Name:O'CONNELL, RACHAEL AMY (ND)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:AMY
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 SW MARLOW AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5105
Mailing Address - Country:US
Mailing Address - Phone:503-298-4104
Mailing Address - Fax:503-379-0967
Practice Address - Street 1:1675 SW MARLOW AVE STE 301
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5105
Practice Address - Country:US
Practice Address - Phone:503-298-4104
Practice Address - Fax:503-379-0967
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19-1784175F00000X
OR4255175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath