Healthcare Provider Details

I. General information

NPI: 1649188848
Provider Name (Legal Business Name): VIVIAN REBELO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PEARL ST STE 1700
BROCKTON MA
02301-2865
US

IV. Provider business mailing address

1345 NORTON AVE
TAUNTON MA
02780-7223
US

V. Phone/Fax

Practice location:
  • Phone: 508-427-0525
  • Fax:
Mailing address:
  • Phone: 774-409-5317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTL36914
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: