NPIMap

Organization Active NPI

Peachcare Rehabilitation Services LLC

  • Occupational Therapist
  • Bonaire, GA
National Provider Identifier
1386301463
Registry record updated Feb 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
PEACHCARE REHABILITATION SERVICES LLC
Practice address
610 Foxborough LN
Bonaire, GA 31005-3663
Phone
(478) 952-4149
NPI assigned
Nov 23, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Scott McDaniel, OTR/LNPI 1003367897
Title
Owner/Occupational Therapist
Phone
(478) 952-4149

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225X00000X Primary
Physical Rehabilitation Occupational TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225XP0019X
Driving and Community Mobility Occupational TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225XR0403X

Addresses

Primary practice location

610 Foxborough LN
Bonaire, GA 31005-3663

Mailing address

610 Foxborough LN
Bonaire, GA 31005-3663
Phone (478) 952-4149

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220225002269 GA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5698169175 Receives reassigned benefits from 4 practitioners
Practice locations: Eatonton, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644969600000",
    "number": "1386301463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 FOXBOROUGH LN",
            "city": "BONAIRE",
            "state": "GA",
            "postal_code": "310053663",
            "telephone_number": "478-952-4149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 FOXBOROUGH LN",
            "city": "BONAIRE",
            "state": "GA",
            "postal_code": "310053663",
            "telephone_number": "478-952-4149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHCARE REHABILITATION SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-23",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER/OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "478-952-4149",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XR0403X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist, Driving and Community Mobility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonaire, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.