Provider Demographics
NPI:1184345621
Name:DEARBORN, RACHEL MAEGEN
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MAEGEN
Last Name:DEARBORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:MAEGEN
Other - Last Name:MCINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8019 GRAYHAWK CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3216
Mailing Address - Country:US
Mailing Address - Phone:907-830-2287
Mailing Address - Fax:
Practice Address - Street 1:3901 OLD SEWARD HWY STE 11
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6089
Practice Address - Country:US
Practice Address - Phone:907-205-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK197459225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist