MEDICARE: MRS. REBEKAH A O'CONNOR M.S., CCC, SLP

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	235Z00000X	Speech-Language Pathologist	SLP004223	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184702458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBEKAH A O'CONNOR M.S., CCC, SLP

Provider Business Mailing Address
First Line	:	3295 LAKE SEMINOLE PL
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-3781
Country	:	US
Telephone Number	:	770-614-5646
Fax Number	:

Provider Business Practice Location Address
First Line	:	3295 LAKE SEMINOLE PL
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-3781
Country	:	US
Telephone Number	:	770-614-5646
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	09/05/2008

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