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NPI Code Detail

MEDICARE: RUSTY G BECKER OTR/L

MEDICARE: RUSTY G BECKER OTR/L
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
1225XP0200XPediatric Occupational Therapist2334AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
224EX37RHOTHERALBCBS PHYS NUMBER

General Provider Information

NPI Number : 1609966480
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUSTY G BECKER OTR/L
Provider Business Mailing Address
First Line : 399 MOUNTAIN RIDGE RD
Second Line :
City : MILLBROOK
State : AL
Zip : 36054-2128
Country : US
Telephone Number : 334-285-7101
Fax Number :
Provider Business Practice Location Address
First Line : 340 MENDEL PKWY W
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-5406
Country : US
Telephone Number : 334-532-0220
Fax Number : 334-532-0221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 02/11/2015

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