Provider Demographics
NPI:1750032793
Name:RACHELL, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:RACHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 EMERSON WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-1468
Mailing Address - Country:US
Mailing Address - Phone:317-457-4216
Mailing Address - Fax:
Practice Address - Street 1:5435 EMERSON WAY STE 300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1468
Practice Address - Country:US
Practice Address - Phone:317-457-4216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management