Provider Demographics
NPI:1730063157
Name:BOELKE, RACHAEL SUSAN (MAS-4345 MA 61150034)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:SUSAN
Last Name:BOELKE
Suffix:
Gender:F
Credentials:MAS-4345 MA 61150034
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18413 E COWLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-9524
Mailing Address - Country:US
Mailing Address - Phone:509-863-8030
Mailing Address - Fax:
Practice Address - Street 1:2151 W HAYDEN AVE
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-7414
Practice Address - Country:US
Practice Address - Phone:208-762-6772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-4345225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist