Basic Information
| Provider Information | |||||||||
| NPI: | 1790749265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEBE | ||||||||
| FirstName: | RACHELLE | ||||||||
| MiddleName: | LANEA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ATC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VARBLE | ||||||||
| OtherFirstName: | RACHELLE | ||||||||
| OtherMiddleName: | LANEA | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | ATC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 112 PHYLLISAIRE CT | ||||||||
| Address2: | |||||||||
| City: | ST PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633766553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6365773936 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 221 SPENCER RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ST PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633762438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6364779911 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 2005024099 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.