Provider Demographics
NPI:1720334022
Name:BULLIS, RACHEL (MS, OTR)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BULLIS
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8112 W BLUEMOUND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3356
Mailing Address - Country:US
Mailing Address - Phone:414-727-5552
Mailing Address - Fax:414-727-5553
Practice Address - Street 1:8112 W BLUEMOUND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-3356
Practice Address - Country:US
Practice Address - Phone:414-727-5552
Practice Address - Fax:414-727-5553
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5213-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist