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General NPI Number Information
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NPI Number | 1184862252
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Entity Type | Individual
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Provider Name | REBECA CAROLINA GROSS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 01/28/2009
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Provider Practice Location Address
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Address Line | 1700 MARLANDWOOD RD
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City | TEMPLE
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State | TX
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Zip | 76502-2842
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Country | US
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Telephone | 186-630-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 3825 LAKE TRAIL DR
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City | KENNER
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State | LA
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Zip | 70065-3315
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Country | US
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Telephone | 504-628-1101
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTT.200268
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License Number State | LA
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