Provider Demographics
NPI:1184976235
Name:CURTIS, RACHAEL MICHELLE (M ED)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:MICHELLE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 327
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74965-9550
Mailing Address - Country:US
Mailing Address - Phone:479-228-3372
Mailing Address - Fax:
Practice Address - Street 1:27753 S WELLING RD
Practice Address - Street 2:
Practice Address - City:WELLING
Practice Address - State:OK
Practice Address - Zip Code:74471-2202
Practice Address - Country:US
Practice Address - Phone:918-457-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100708280CMedicaid