Provider Demographics
NPI:1699307744
Name:BOUSMAN, RACHAEL (CAT, MED)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:BOUSMAN
Suffix:
Gender:F
Credentials:CAT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 WAIKULU DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4953
Mailing Address - Country:US
Mailing Address - Phone:513-582-2972
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 4077 HARRIS AVE
Practice Address - Street 2:MARINE CORPS BASE HAWAII
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-496-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAT-4152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty