Basic Information
| Provider Information | |||||||||
| NPI: | 1396115556 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ELDER | ||||||||
| FirstName: | RACHEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1561 GOLF LN | ||||||||
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| City: | LIVINGSTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385702110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312672396 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 BLUE RIDGE ST | ||||||||
| Address2: | |||||||||
| City: | MARTINSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241127261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766388701 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 09/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5232 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.