Provider Demographics
NPI:1134717077
Name:STAUB, RACHEL (LMT, DS-SI)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:STAUB
Suffix:
Gender:F
Credentials:LMT, DS-SI
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:STAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:719 SIMPSON RUN RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-7807
Mailing Address - Country:US
Mailing Address - Phone:304-517-0510
Mailing Address - Fax:
Practice Address - Street 1:719 SIMPSON RUN RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-7807
Practice Address - Country:US
Practice Address - Phone:304-517-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV225700000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist