Provider Demographics
NPI:1023675550
Name:MEACHUM, RACHAEL NICOLE (LMT)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:NICOLE
Last Name:MEACHUM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 N 800 EAST RD
Mailing Address - Street 2:
Mailing Address - City:TOWER HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62571-8211
Mailing Address - Country:US
Mailing Address - Phone:217-827-3528
Mailing Address - Fax:
Practice Address - Street 1:1726 N 800 EAST RD
Practice Address - Street 2:
Practice Address - City:TOWER HILL
Practice Address - State:IL
Practice Address - Zip Code:62571-8211
Practice Address - Country:US
Practice Address - Phone:217-827-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22701924225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty