Provider Demographics
NPI:1720555923
Name:RAINEY, THERESA ANNE
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANNE
Last Name:RAINEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 CHESTNUT TREE DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5113
Mailing Address - Country:US
Mailing Address - Phone:410-562-7515
Mailing Address - Fax:
Practice Address - Street 1:14299 BENEDICTINE LN
Practice Address - Street 2:
Practice Address - City:RIDGELY
Practice Address - State:MD
Practice Address - Zip Code:21660-1434
Practice Address - Country:US
Practice Address - Phone:410-634-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05743225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist