Provider Demographics
NPI:1710217856
Name:CARROLL, RACHAEL (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:RACHAEL
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-6812
Mailing Address - Country:US
Mailing Address - Phone:864-593-8515
Mailing Address - Fax:
Practice Address - Street 1:379 PINEHAVEN ST EXT
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360
Practice Address - Country:US
Practice Address - Phone:864-984-6584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2896224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant