Provider Demographics
NPI:1679398549
Name:COOPER, RACHAEL MAE (RD,LD)
Entity type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:MAE
Last Name:COOPER
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3465 SANDLER BLVD UNIT 5208
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-6327
Mailing Address - Country:US
Mailing Address - Phone:910-899-8962
Mailing Address - Fax:
Practice Address - Street 1:3465 SANDLER BLVD UNIT 5208
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-6327
Practice Address - Country:US
Practice Address - Phone:910-899-8962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2905133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered