Provider Demographics
NPI:1295390664
Name:SMITH, RACHEL RENEE (OTA/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S GENERALS BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3656
Mailing Address - Country:US
Mailing Address - Phone:704-735-8065
Mailing Address - Fax:
Practice Address - Street 1:515 S GENERALS BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3656
Practice Address - Country:US
Practice Address - Phone:704-735-8065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9825224ZF0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantFeeding, Eating & Swallowing
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1740301050Medicaid