Provider Demographics
NPI:1780948547
Name:SPAIDE, RACHEL BETH (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:BETH
Last Name:SPAIDE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:BETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:14 SOUTHBROOKE PL
Mailing Address - Street 2:
Mailing Address - City:MT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-9708
Mailing Address - Country:US
Mailing Address - Phone:217-864-1359
Mailing Address - Fax:
Practice Address - Street 1:1800 E LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3810
Practice Address - Country:US
Practice Address - Phone:217-464-2981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056003226225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist