Provider Demographics
NPI:1760930945
Name:SHELL, RACHEL STEWART (MT-BC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:STEWART
Last Name:SHELL
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 BOONSBORO RD
Mailing Address - Street 2:APT 51
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2255
Mailing Address - Country:US
Mailing Address - Phone:434-221-5800
Mailing Address - Fax:
Practice Address - Street 1:4715 BOONSBORO RD
Practice Address - Street 2:APT 51
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2255
Practice Address - Country:US
Practice Address - Phone:434-221-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11884225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist