Provider Demographics
NPI:1275933525
Name:SPIVEY, RAEGAN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:RAEGAN
Middle Name:
Last Name:SPIVEY
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 1:521 LAKESIDE CT
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-1911
Mailing Address - Country:US
Mailing Address - Phone:843-229-3596
Mailing Address - Fax:
Practice Address - Street 1:1727 BUCK SWAMP RD
Practice Address - Street 2:
Practice Address - City:FORK
Practice Address - State:SC
Practice Address - Zip Code:29543-6116
Practice Address - Country:US
Practice Address - Phone:877-311-2675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-23
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4015225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist