Healthcare Provider Details

I. General information

NPI: 1548401276
Provider Name (Legal Business Name): MS. REBECCA A MABRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 INTERNATIONAL PKWY SUITE 300
LAKE MARY FL
32746-5061
US

IV. Provider business mailing address

60 BUTTERFLY DR
MURRAY KY
42071-5432
US

V. Phone/Fax

Practice location:
  • Phone: 800-806-6026
  • Fax:
Mailing address:
  • Phone: 270-227-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberKY-A3263
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: