Healthcare Provider Details

I. General information

NPI: 1447820220
Provider Name (Legal Business Name): RACHEL HARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 STATE AVE
DICKINSON ND
58601-4660
US

IV. Provider business mailing address

683 STATE AVE
DICKINSON ND
58601-4660
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-9400
  • Fax:
Mailing address:
  • Phone: 229-726-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number455038
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: