Provider Demographics
NPI:1134660533
Name:GILLESPIE, RACHEL (ATC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 LINDEN ST
Mailing Address - Street 2:APT 3
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-3467
Mailing Address - Country:US
Mailing Address - Phone:937-673-2046
Mailing Address - Fax:
Practice Address - Street 1:709 OKLAHOMA BLVD
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2749
Practice Address - Country:US
Practice Address - Phone:580-327-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAT8632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer