Basic Information
| Provider Information | |||||||||
| NPI: | 1164056586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAINEY | ||||||||
| FirstName: | MIRANDA | ||||||||
| MiddleName: | BOOTH | ||||||||
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| Credential: | MS, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 587 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272930587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362366546 | ||||||||
| FaxNumber: | 3362369546 | ||||||||
| Practice Location | |||||||||
| Address1: | 440 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272922634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362366546 | ||||||||
| FaxNumber: | 3362369546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2020 | ||||||||
| LastUpdateDate: | 02/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 13115 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.