Healthcare Provider Details

I. General information

NPI: 1245663103
Provider Name (Legal Business Name): RACHAEL WUESTEFELD ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13480 N STATE ROAD 229
BATESVILLE IN
47006-9098
US

IV. Provider business mailing address

13480 N STATE ROAD 229
BATESVILLE IN
47006-9098
US

V. Phone/Fax

Practice location:
  • Phone: 812-212-1498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36002127A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: