Provider Demographics
NPI:1952280992
Name:NOCK, RAECHEL NICOLE BRITTON
Entity type:Individual
Prefix:
First Name:RAECHEL
Middle Name:NICOLE BRITTON
Last Name:NOCK
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 E WOODBURY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2853
Mailing Address - Country:US
Mailing Address - Phone:326-203-7141
Mailing Address - Fax:
Practice Address - Street 1:77 E WOODBURY DR STE 110
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2853
Practice Address - Country:US
Practice Address - Phone:326-203-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist