Provider Demographics
NPI:1578353660
Name:BONI, RACHEL MARIE
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MARIE
Last Name:BONI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:524 S BRISTOW AVE
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-2341
Mailing Address - Country:US
Mailing Address - Phone:918-810-0190
Mailing Address - Fax:
Practice Address - Street 1:524 S BRISTOW AVE
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-2341
Practice Address - Country:US
Practice Address - Phone:918-810-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator