Provider Demographics
NPI:1861210262
Name:VENABLE, RACHEL DAVENPORT (COTA/L)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:DAVENPORT
Last Name:VENABLE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LAUREN
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1949 BELLVIEW CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-7019
Mailing Address - Country:US
Mailing Address - Phone:864-981-4285
Mailing Address - Fax:
Practice Address - Street 1:1650 GALISTEO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4747
Practice Address - Country:US
Practice Address - Phone:864-981-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5403224Z00000X
NMOT-2023-0267224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant