Provider Demographics
NPI:1447436324
Name:MIRECKI, RACHEL NICOLE (OT)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:NICOLE
Last Name:MIRECKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:NICOLE
Other - Last Name:FEUERHAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:17428 FOX BEND LN
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-4653
Mailing Address - Country:US
Mailing Address - Phone:507-382-1827
Mailing Address - Fax:708-433-5327
Practice Address - Street 1:19100 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-7510
Practice Address - Country:US
Practice Address - Phone:708-478-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932114OtherBLUE CROSS BLUE SHIELD