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NPI Code Detail

MEDICARE: RACHEL RENAE LAKE OTR/L

MEDICARE: RACHEL RENAE LAKE OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist5805SC

General Provider Information

NPI Number : 1356619167
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL RENAE LAKE OTR/L
Provider Business Mailing Address
First Line : 85C VINCENT DR
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29464-4030
Country : US
Telephone Number : 248-894-4725
Fax Number :
Provider Business Practice Location Address
First Line : 85C VINCENT DR
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29464-4030
Country : US
Telephone Number : 248-894-4725
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2011
Last Update Date : 03/18/2020

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Directions to “ RACHEL RENAE LAKE OTR/L” Practice Location

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