Provider Demographics
NPI:1447557244
Name:PETERSON, RACHEL NICHOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:NICHOLE
Last Name:PETERSON
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 1:121 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2430
Mailing Address - Country:US
Mailing Address - Phone:864-553-6376
Mailing Address - Fax:
Practice Address - Street 1:379 PINEHAVEN STREET EXT
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2672
Practice Address - Country:US
Practice Address - Phone:864-984-6584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3642225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist