Provider Demographics
NPI:1235788894
Name:RIGNEY, JORDAN BLAIRE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:BLAIRE
Last Name:RIGNEY
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 1:3434 LAURENS RD APT 517
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5281
Mailing Address - Country:US
Mailing Address - Phone:304-550-8804
Mailing Address - Fax:
Practice Address - Street 1:28 JIMMY DOOLITTLE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2622
Practice Address - Country:US
Practice Address - Phone:864-679-8606
Practice Address - Fax:864-679-8608
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5637225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist