MEDICARE: RACHEL LYNN BOCKELMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275148645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL LYNN BOCKELMAN

Provider Business Mailing Address
First Line	:	2811 YOUNGSTOWN KINGSVILLE RD
Second Line	:
City	:	CORTLAND
State	:	OH
Zip	:	44410-9486
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 YOUNGSTOWN KINGSVILLE RD
Second Line	:
City	:	CORTLAND
State	:	OH
Zip	:	44410-9486
Country	:	US
Telephone Number	:	330-240-2670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2020
Last Update Date	:	09/12/2020

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Directions to “ RACHEL LYNN BOCKELMAN ” Practice Location

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