Provider Demographics
NPI:1780090985
Name:PURNELL, RAELENE JOYCE (ATC)
Entity type:Individual
Prefix:
First Name:RAELENE
Middle Name:JOYCE
Last Name:PURNELL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ATLANTA AVE
Mailing Address - Street 2:APT C
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5308
Mailing Address - Country:US
Mailing Address - Phone:949-355-5629
Mailing Address - Fax:
Practice Address - Street 1:211 ATLANTA AVE
Practice Address - Street 2:APT C
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5308
Practice Address - Country:US
Practice Address - Phone:949-355-5629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer