Provider Demographics
NPI:1275953085
Name:MARTIN, RAECHAL (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:RAECHAL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-6333
Mailing Address - Country:US
Mailing Address - Phone:620-276-0422
Mailing Address - Fax:620-275-3282
Practice Address - Street 1:801 N CAMPUS DR
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6333
Practice Address - Country:US
Practice Address - Phone:620-276-0422
Practice Address - Fax:620-275-3282
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-008862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer