Healthcare Provider Details

I. General information

NPI: 1225696156
Provider Name (Legal Business Name): REBECCA O'CONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N HENDERSON RD STE 200
KING OF PRUSSIA PA
19406-4422
US

IV. Provider business mailing address

170 N HENDERSON RD STE 200
KING OF PRUSSIA PA
19406-4422
US

V. Phone/Fax

Practice location:
  • Phone: 856-346-0005
  • Fax:
Mailing address:
  • Phone: 856-346-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH005833
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-85487
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: