Provider Demographics
NPI:1184097644
Name:RAVENEL, ANNE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:RAVENEL
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 1:28 BEVERLY RD
Mailing Address - Street 2:APT A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28 BEVERLY RD
Practice Address - Street 2:APT A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7564
Practice Address - Country:US
Practice Address - Phone:843-670-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2959224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant