Provider Demographics
NPI:1689155947
Name:NIZIOLEK, RACHEL JOY (COMS, MA)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:JOY
Last Name:NIZIOLEK
Suffix:
Gender:F
Credentials:COMS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 KRAMER LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2064
Mailing Address - Country:US
Mailing Address - Phone:410-303-3626
Mailing Address - Fax:
Practice Address - Street 1:4711 KRAMER LN
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-2064
Practice Address - Country:US
Practice Address - Phone:410-303-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI744722225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training ProviderGroup - Single Specialty