Provider Demographics
NPI:1558481515
Name:EMRICK, RAE LEE (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:LEE
Last Name:EMRICK
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:90 CLARKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-8400
Mailing Address - Country:US
Mailing Address - Phone:304-472-8032
Mailing Address - Fax:304-473-8349
Practice Address - Street 1:59 COLLEGE AVE
Practice Address - Street 2:WEST VIRGINIA WESLEYAN COLLEGE
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2600
Practice Address - Country:US
Practice Address - Phone:304-473-8002
Practice Address - Fax:304-473-8349
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer