Provider Demographics
NPI:1285246249
Name:WILES, RACHEL DEONNA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:DEONNA
Last Name:WILES
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SAMUEL WAY NW
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-4637
Mailing Address - Country:US
Mailing Address - Phone:706-371-1933
Mailing Address - Fax:
Practice Address - Street 1:13291 HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4455
Practice Address - Country:US
Practice Address - Phone:678-424-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist