Provider Demographics
NPI:1962047928
Name:MCDANIELS, RACHEL (ATC, LAT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MCDANIELS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NOAH LN
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-6135
Mailing Address - Country:US
Mailing Address - Phone:618-967-5836
Mailing Address - Fax:
Practice Address - Street 1:1403 JOE ABBOTT WAY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-4649
Practice Address - Country:US
Practice Address - Phone:618-993-6237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0045052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer