Provider Demographics
NPI:1548864911
Name:DAVIS, RACHEL JENNIFER (MT-BC)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:JENNIFER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9045 GREEN MEADOWS WAY
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-5741
Mailing Address - Country:US
Mailing Address - Phone:321-615-5029
Mailing Address - Fax:
Practice Address - Street 1:9045 GREEN MEADOWS WAY
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-5741
Practice Address - Country:US
Practice Address - Phone:321-615-5029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14921225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist