Provider Demographics
NPI:1609607878
Name:GOETZ, RACHEL EMILY
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:EMILY
Last Name:GOETZ
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 1:2043 RANDOM RD APT 401
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-5917
Mailing Address - Country:US
Mailing Address - Phone:440-715-3133
Mailing Address - Fax:
Practice Address - Street 1:3518 W 25TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1951
Practice Address - Country:US
Practice Address - Phone:216-741-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2403819390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program