Individual
RACHEL ANN MCDERMOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
513 PINE LAKE AVE, LA PORTE, IN 46350-2316
(219) 326-1082
(219) 326-1413
Mailing address
513 PINE LAKE AVE, LA PORTE, IN 46350-2316
(219) 326-1082
(219) 326-1413
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
16-012191-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201364430
MEDICAID LPI
IN
Enumeration date
11/09/2016
Last updated
11/09/2016
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