MEDICARE: MRS. REBECCA LYNN WOODARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1154836690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA LYNN WOODARD

Provider Business Mailing Address
First Line	:	4713 PARKHAVEN DR
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-7577
Country	:	US
Telephone Number	:	972-240-5628
Fax Number	:	866-740-7952

Provider Business Practice Location Address
First Line	:	9872 OSPREY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4339
Country	:	US
Telephone Number	:	817-243-8589
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	12/06/2017

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