Individual
RACHEAL S IKUBISEHIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7800 WILSON AVE, PARKVILLE, MD 21234-5825
(443) 824-5678
Mailing address
7800 WILSON AVE, PARKVILLE, MD 21234-5825
(443) 824-5678
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4108893000
—
MD
Enumeration date
04/02/2020
Last updated
04/02/2020
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