Provider Demographics
NPI:1609567502
Name:DEMENT, RAECHEL (CMT)
Entity Type:Individual
Prefix:
First Name:RAECHEL
Middle Name:
Last Name:DEMENT
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 GOLFVIEW RD.
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-1271
Mailing Address - Country:US
Mailing Address - Phone:847-624-2026
Mailing Address - Fax:
Practice Address - Street 1:937 N. PLUMGROVE RD.
Practice Address - Street 2:SUITE D
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173
Practice Address - Country:US
Practice Address - Phone:630-912-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.008468225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist