Provider Demographics
NPI:1285010041
Name:CLAYDON, RACHELLE M (LMT)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:M
Last Name:CLAYDON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:M
Other - Last Name:DIENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-2111
Mailing Address - Country:US
Mailing Address - Phone:406-777-1048
Mailing Address - Fax:406-777-1038
Practice Address - Street 1:212 MAIN ST
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2111
Practice Address - Country:US
Practice Address - Phone:406-777-1048
Practice Address - Fax:406-777-1038
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist