Provider Demographics
NPI:1356594170
Name:POPE, RACHEL RUSSELL (OTR/L)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:RUSSELL
Last Name:POPE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 WILLOW OAK LN
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-3415
Mailing Address - Country:US
Mailing Address - Phone:912-876-3066
Mailing Address - Fax:
Practice Address - Street 1:427 WILLOW OAK LN
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3415
Practice Address - Country:US
Practice Address - Phone:912-876-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4380225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist