Provider Demographics
NPI:1689062648
Name:DENISON, RACHEL (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:DENISON
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27139 BAKER DR
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-9152
Mailing Address - Country:US
Mailing Address - Phone:269-251-6950
Mailing Address - Fax:
Practice Address - Street 1:27139 BAKER DR
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-9152
Practice Address - Country:US
Practice Address - Phone:269-251-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002215A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer