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General NPI Number Information
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NPI Number | 1114343605
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Entity Type | Individual
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Provider Name | REBECCA JANE BEDARD ATC
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Gender | Female
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Dates
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Enumeration Date | 03/09/2014
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Last Update Date | 03/09/2014
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Provider Practice Location Address
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Address Line | 59 EXECUTIVE PARK S SUITE 1000
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City | ATLANTA
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State | GA
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Zip | 30329-2208
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Country | US
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Telephone | 404-778-7137
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 PIEDMONT AVE NE APT C4
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City | ATLANTA
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State | GA
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Zip | 30309-3732
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Country | US
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Telephone | 413-237-0665
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 2000001376
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 13-0618
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License Number State | NY
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