Healthcare Provider Details

I. General information

NPI: 1851907687
Provider Name (Legal Business Name): REBECCA VICTORY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 EAST AVE
ROCHESTER NY
14618-3428
US

IV. Provider business mailing address

11 CLOVER PARK DR APT 4
ROCHESTER NY
14618-4520
US

V. Phone/Fax

Practice location:
  • Phone: 585-381-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number024981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: