Healthcare Provider Details

I. General information

NPI: 1811129802
Provider Name (Legal Business Name): REBECCA SCHMIDT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 09/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S MAIN ST
CRESTVIEW FL
32536-4252
US

IV. Provider business mailing address

1319 JEFFERYSCOT DR
CRESTVIEW FL
32536-2224
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-7772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT10320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: