MEDICARE: RACHAEL DUNAHOO ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	2000028496	IA

General Provider Information

NPI Number	:	1598294472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL DUNAHOO ATC

Provider Business Mailing Address
First Line	:	245 E WILLOW AVE APT 417
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-5495
Country	:	US
Telephone Number	:	563-468-9434
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEMORIAL FIELD HOUSE 319 S MARKET ST
Second Line	:
City	:	NEW WILMINGTON
State	:	PA
Zip	:	16172-0001
Country	:	US
Telephone Number	:	563-468-9434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	06/05/2017

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