Provider Demographics
NPI:1942658661
Name:FREDERICY, RACHEL DEE
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:DEE
Last Name:FREDERICY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 TOWNSHIP ROAD 581
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:OH
Mailing Address - Zip Code:44880-9768
Mailing Address - Country:US
Mailing Address - Phone:216-536-3570
Mailing Address - Fax:
Practice Address - Street 1:279 TOWNSHIP ROAD 581
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:OH
Practice Address - Zip Code:44880-9768
Practice Address - Country:US
Practice Address - Phone:216-536-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0162134Medicaid