Basic Information
Provider Information | |||||||||
NPI: | 1174993729 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SPENCER | ||||||||
FirstName: | RACHEL | ||||||||
MiddleName: | MINK | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | OTR/L | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MINK | ||||||||
OtherFirstName: | RACHEL | ||||||||
OtherMiddleName: | KLARA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | OTR/L | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2880 TRICOM ST | ||||||||
Address2: |   | ||||||||
City: | NORTH CHARLESTON | ||||||||
State: | SC | ||||||||
PostalCode: | 294069171 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8437975050 | ||||||||
FaxNumber: | 8437973633 | ||||||||
Practice Location | |||||||||
Address1: | 202 NEXTON SQUARE DR | ||||||||
Address2: |   | ||||||||
City: | SUMMERVILLE | ||||||||
State: | SC | ||||||||
PostalCode: | 294867911 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8544294263 | ||||||||
FaxNumber: | 8437678569 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/25/2015 | ||||||||
LastUpdateDate: | 07/17/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/17/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 4594 | SC | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   | 225XH1200X | 4594 | SC | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
ID | Type | State | Issuer | Description | 7000950005 | 01 | SC | ARCIS HEALTHCARE, LLC GROUP MEDICARE DME PTAN | OTHER | GP6337 | 01 | SC | ARCIS HEALTHCARE GROUP MEDICAID NO. | OTHER | P01555383 | 01 | SC | RAILROAD MEDICARE | OTHER | 7000950004 | 01 | SC | ARCIS HEALTHCARE, LLC GROUP MEDICARE DME PTAN | OTHER | D043 | 01 | SC | ARCIS HEALTHCARE GROUP MEDICARE PTAN | OTHER | TH3009 | 05 | SC |   | MEDICAID |