Healthcare Provider Details

I. General information

NPI: 1831908011
Provider Name (Legal Business Name): RACHEL ANNE SPECHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W CIRCLE DR
EAST LANSING MI
48824-3700
US

IV. Provider business mailing address

5171 TWINGING DR
OKEMOS MI
48864-2979
US

V. Phone/Fax

Practice location:
  • Phone: 517-355-4730
  • Fax:
Mailing address:
  • Phone: 519-948-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: