Provider Demographics
NPI:1477806883
Name:MCCLOSKEY, RACHELE RAE
Entity Type:Individual
Prefix:MRS
First Name:RACHELE
Middle Name:RAE
Last Name:MCCLOSKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RACHELE
Other - Middle Name:RAE
Other - Last Name:DEMINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:472 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9273
Mailing Address - Country:US
Mailing Address - Phone:740-649-6253
Mailing Address - Fax:
Practice Address - Street 1:472 CLARK RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9273
Practice Address - Country:US
Practice Address - Phone:740-649-6253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH501112650506376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide