Provider Demographics
NPI:1700140688
Name:FAULKNER, RACHAL NICHOLE
Entity Type:Individual
Prefix:
First Name:RACHAL
Middle Name:NICHOLE
Last Name:FAULKNER
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 1:1672 SCIENCE RIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40337
Mailing Address - Country:US
Mailing Address - Phone:859-398-8567
Mailing Address - Fax:
Practice Address - Street 1:1672 SCIENCE RIDGE RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:KY
Practice Address - Zip Code:40337-9686
Practice Address - Country:US
Practice Address - Phone:859-398-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist