Provider Demographics
NPI:1740529825
Name:BURDETTE, RACHEL NICOLE (MS ATC, OTC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:NICOLE
Last Name:BURDETTE
Suffix:
Gender:F
Credentials:MS ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S CLEARVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-1015
Mailing Address - Country:US
Mailing Address - Phone:504-736-4800
Mailing Address - Fax:504-736-4810
Practice Address - Street 1:1201 S CLEARVIEW PKWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-1015
Practice Address - Country:US
Practice Address - Phone:504-736-4800
Practice Address - Fax:504-736-4810
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12-0802246ZS0410X
LAATH.2003482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer