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General NPI Number Information
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NPI Number | 1386288215
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Entity Type | Individual
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Provider Name | LEAH RAUCH LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 1 WILDCAT LN
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City | BROOKVILLE
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State | IN
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Zip | 47012-8100
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Country | US
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Telephone | 765-647-4101
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Fax |
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Provider Business Mailing Address
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Address Line | 26965 DOGRIDGE RD
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City | BROOKVILLE
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State | IN
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Zip | 47012-9091
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Country | US
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Telephone | 513-375-3760
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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 | 36002448A
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License Number State | IN
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