Provider Demographics
NPI:1538724752
Name:RADEMAKER, MARY A (MAT, MS ED, MS IECE)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:RADEMAKER
Suffix:
Gender:F
Credentials:MAT, MS ED, MS IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 REBA JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-8578
Mailing Address - Country:US
Mailing Address - Phone:812-786-9111
Mailing Address - Fax:
Practice Address - Street 1:320 REBA JACKSON DR
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-8578
Practice Address - Country:US
Practice Address - Phone:812-786-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist