Healthcare Provider Details

I. General information

NPI: 1386301463
Provider Name (Legal Business Name): PEACHCARE REHABILITATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 FOXBOROUGH LN
BONAIRE GA
31005-3663
US

IV. Provider business mailing address

610 FOXBOROUGH LN
BONAIRE GA
31005-3663
US

V. Phone/Fax

Practice location:
  • Phone: 478-952-4149
  • Fax:
Mailing address:
  • Phone: 478-952-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT MCDANIEL
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 478-952-4149