Provider Demographics
NPI:1982292207
Name:MARTIN, RACHEL JOY (BSDH, COM)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:JOY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BSDH, COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LAURELWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WAKARUSA
Mailing Address - State:IN
Mailing Address - Zip Code:46573-8506
Mailing Address - Country:US
Mailing Address - Phone:574-370-4760
Mailing Address - Fax:
Practice Address - Street 1:2851 E BRISTOL ST STE A
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-4381
Practice Address - Country:US
Practice Address - Phone:574-230-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-03
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty