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General NPI Number Information
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NPI Number | 1346529708
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Entity Type | Individual
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Provider Name | REBEKAH DIANE ICE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 1604 SW 93RD ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-7112
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Country | US
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Telephone | 405-919-9025
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Fax |
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Provider Business Mailing Address
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Address Line | 1604 SW 93RD ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-7112
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Country | US
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Telephone | 405-919-9025
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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 | 1613
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.008779
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3049
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License Number State | CO
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