Provider Demographics
NPI:1053501858
Name:GROOMS, RACHEL RAMSEY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:RAMSEY
Last Name:GROOMS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 THOMAS WALTERS RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29468-3289
Mailing Address - Country:US
Mailing Address - Phone:843-351-4506
Mailing Address - Fax:803-395-2097
Practice Address - Street 1:111 JOHN LAWSON AVE
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:SC
Practice Address - Zip Code:29412
Practice Address - Country:US
Practice Address - Phone:803-395-2090
Practice Address - Fax:803-395-2097
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2507225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC216535Medicaid
SC216535Medicaid