Healthcare Provider Details

I. General information

NPI: 1609966480
Provider Name (Legal Business Name): RUSTY G BECKER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MENDEL PKWY W
MONTGOMERY AL
36117-5406
US

IV. Provider business mailing address

399 MOUNTAIN RIDGE RD
MILLBROOK AL
36054-2128
US

V. Phone/Fax

Practice location:
  • Phone: 334-532-0220
  • Fax: 334-532-0221
Mailing address:
  • Phone: 334-285-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2334
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: