Healthcare Provider Details

I. General information

NPI: 1295905701
Provider Name (Legal Business Name): REBECCA BURNETTE THOMAS MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HUMPHREYS BLVD
MEMPHIS TN
38120-2146
US

IV. Provider business mailing address

900 SHERIDAN ST
MEMPHIS TN
38107-4611
US

V. Phone/Fax

Practice location:
  • Phone: 901-747-1800
  • Fax: 901-747-1801
Mailing address:
  • Phone: 901-734-6411
  • Fax: 901-747-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT0000001418
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: