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General NPI Number Information
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NPI Number | 1306320866
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Entity Type | Individual
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Provider Name | RACHEL O'BOYLE MS, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 8135 S WESTNEDGE AVE
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City | PORTAGE
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State | MI
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Zip | 49002-5433
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Country | US
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Telephone | 269-323-5337
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Fax |
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Provider Business Mailing Address
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Address Line | 1818 PARKCREST DR SW APT 19
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City | WYOMING
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State | MI
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Zip | 49519-9384
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601001601
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License Number State | MI
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