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General NPI Number Information
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NPI Number | 1780948547
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Entity Type | Individual
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Provider Name | RACHEL BETH SPAIDE MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 1800 E LAKE SHORE DR
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City | DECATUR
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State | IL
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Zip | 62521-3810
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Country | US
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Telephone | 217-464-2981
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Fax |
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Provider Business Mailing Address
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Address Line | 14 SOUTHBROOKE PL
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City | MT ZION
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State | IL
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Zip | 62549-9708
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Country | US
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Telephone | 217-864-1359
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056003226
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License Number State | IL
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