Provider Demographics
NPI:1568628998
Name:HARTLEY, RACHAEL WALLACE (RD)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:WALLACE
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1253
Mailing Address - Country:US
Mailing Address - Phone:803-381-3304
Mailing Address - Fax:
Practice Address - Street 1:1898 CALHOUN ST STE 8
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2650
Practice Address - Country:US
Practice Address - Phone:803-381-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered