Healthcare Provider Details

I. General information

NPI: 1811608045
Provider Name (Legal Business Name): RACHEL NICHOLS MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10171 CHUMSTICK HWY
LEAVENWORTH WA
98826-8762
US

IV. Provider business mailing address

10171 CHUMSTICK HWY
LEAVENWORTH WA
98826-8762
US

V. Phone/Fax

Practice location:
  • Phone: 509-548-3133
  • Fax:
Mailing address:
  • Phone: 509-548-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61382641
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: