Provider Demographics
NPI:1235430547
Name:WINTERTON, RACHELLE D (LMT)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:D
Last Name:WINTERTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61984 COTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-5306
Mailing Address - Country:US
Mailing Address - Phone:541-910-0112
Mailing Address - Fax:
Practice Address - Street 1:1910 CEDAR ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1680
Practice Address - Country:US
Practice Address - Phone:541-910-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16285225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist