Provider Demographics
NPI:1063621035
Name:RACUTT, KARRIE MICHELLE
Entity type:Individual
Prefix:MRS
First Name:KARRIE
Middle Name:MICHELLE
Last Name:RACUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 RYEHILL DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8668
Mailing Address - Country:US
Mailing Address - Phone:815-919-8608
Mailing Address - Fax:815-725-5150
Practice Address - Street 1:212 BARNEY DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5271
Practice Address - Country:US
Practice Address - Phone:815-725-2194
Practice Address - Fax:815-725-5150
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist