Healthcare Provider Details

I. General information

NPI: 1356052625
Provider Name (Legal Business Name): RACHEL M KAMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 44TH ST SW
GRANDVILLE MI
49418-2177
US

IV. Provider business mailing address

3831 WHISPERING WAY SE APT 303
GRAND RAPIDS MI
49546-7621
US

V. Phone/Fax

Practice location:
  • Phone: 616-344-4508
  • Fax:
Mailing address:
  • Phone: 616-900-4386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number106S0000000X
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: