Provider Demographics
NPI:1568281061
Name:BLANK, RACHEL C
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:C
Last Name:BLANK
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 1:10136 CARNATION CT APT 1
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-3270
Mailing Address - Country:US
Mailing Address - Phone:859-669-0263
Mailing Address - Fax:999-999-9999
Practice Address - Street 1:961 MERRITT GROVE LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-5713
Practice Address - Country:US
Practice Address - Phone:859-669-0263
Practice Address - Fax:999-999-9999
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child