Provider Demographics
NPI:1124460860
Name:CACHIARAS, JACLYN RAE (ATC, SCAT, LAT, CES)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:RAE
Last Name:CACHIARAS
Suffix:
Gender:F
Credentials:ATC, SCAT, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 WITHERS LN
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4851
Mailing Address - Country:US
Mailing Address - Phone:507-513-1012
Mailing Address - Fax:
Practice Address - Street 1:2093 HENRY TECKLENBURG DR STE 200
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5742
Practice Address - Country:US
Practice Address - Phone:843-209-8781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24292255A2300X
SC21542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer