Provider Demographics
NPI:1083206510
Name:RAINBOW ROOTS, LLC
Entity Type:Organization
Organization Name:RAINBOW ROOTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:SPOON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:614-218-6830
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-0482
Mailing Address - Country:US
Mailing Address - Phone:614-218-6830
Mailing Address - Fax:
Practice Address - Street 1:28 HAMILTON DR
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44813-1286
Practice Address - Country:US
Practice Address - Phone:614-218-6830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty