Healthcare Provider Details

I. General information

NPI: 1013160977
Provider Name (Legal Business Name): REBECCA SUSANNE WURM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHRISTA MCAULIFFE DR
OWEGO NY
13827-1094
US

IV. Provider business mailing address

1277 TAYLOR RD
OWEGO NY
13827-1200
US

V. Phone/Fax

Practice location:
  • Phone: 607-687-6261
  • Fax:
Mailing address:
  • Phone: 607-687-0678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number013341-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: