Provider Demographics
NPI:1679106603
Name:DAVIS, RACHEL LEAH
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEAH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W 1130 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3020
Mailing Address - Country:US
Mailing Address - Phone:801-361-6459
Mailing Address - Fax:
Practice Address - Street 1:1140 W 1130 S
Practice Address - Street 2:BUILDING B
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84102-2888
Practice Address - Country:US
Practice Address - Phone:801-361-6459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician