Provider Demographics
NPI:1932593415
Name:LYDELL, RACHELLE (OTD, MSOT, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:
Last Name:LYDELL
Suffix:
Gender:F
Credentials:OTD, MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100547
Mailing Address - Street 2:LUTHER F. CARTER CENTER #348
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-0547
Mailing Address - Country:US
Mailing Address - Phone:843-661-1667
Mailing Address - Fax:843-661-2551
Practice Address - Street 1:201 W EVANS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3427
Practice Address - Country:US
Practice Address - Phone:843-661-1667
Practice Address - Fax:843-661-2551
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6682225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY019577OtherLICENSE NUMBER