Provider Demographics
NPI:1619643186
Name:BROWN, RACHEL LAYNE RACKLEFF (OTR/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LAYNE RACKLEFF
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:205 FALLEN LEAF DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLET
Mailing Address - State:GA
Mailing Address - Zip Code:30415-0140
Mailing Address - Country:US
Mailing Address - Phone:912-682-9868
Mailing Address - Fax:
Practice Address - Street 1:508 GENTILLY RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5149
Practice Address - Country:US
Practice Address - Phone:912-681-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008171225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist