Basic Information
| Provider Information | |||||||||
| NPI: | 1396360863 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCALL | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | ROSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 290 MAHRT LN SE APT 102 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973175682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9713223543 | ||||||||
| FaxNumber: | 5033612782 | ||||||||
| Practice Location | |||||||||
| Address1: | 3876 BEVERLY AVE NE BLDG G | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973051319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035764536 | ||||||||
| FaxNumber: | 5033612782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2020 | ||||||||
| LastUpdateDate: | 06/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | Y |
No ID Information.