Provider Demographics
NPI:1932338910
Name:HAZEWINKEL, RACHEL (APT)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:HAZEWINKEL
Suffix:
Gender:F
Credentials:APT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 S WESTERN AVE
Mailing Address - Street 2:102
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2997
Mailing Address - Country:US
Mailing Address - Phone:405-691-5434
Mailing Address - Fax:405-692-3703
Practice Address - Street 1:10001 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2997
Practice Address - Country:US
Practice Address - Phone:405-691-5434
Practice Address - Fax:405-692-3703
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200097800AMedicaid
OK370203Medicare Oscar/Certification
OKOK404505Medicare PIN