Provider Demographics
NPI:1356078414
Name:ATWOOD, RACHEL DIVINE (OT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:DIVINE
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:DIVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-206-4158
Mailing Address - Fax:717-773-4654
Practice Address - Street 1:950 E COUNTY LINE RD STE E
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1928
Practice Address - Country:US
Practice Address - Phone:601-853-9747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3979225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist