Provider Demographics
NPI:1164791935
Name:DRAKE, RICHELLE JEANNINE (CLT, MT)
Entity Type:Individual
Prefix:MRS
First Name:RICHELLE
Middle Name:JEANNINE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:CLT, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15117 HAYNES ST.
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1418
Mailing Address - Country:US
Mailing Address - Phone:818-901-6555
Mailing Address - Fax:818-901-6555
Practice Address - Street 1:15117 HAYNES ST.
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1418
Practice Address - Country:US
Practice Address - Phone:818-901-6555
Practice Address - Fax:818-901-6555
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No174400000XOther Service ProvidersSpecialist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies