MEDICARE: REBECCA S STANLEY MOT, 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
1	225X00000X	Occupational Therapist	OT005560	GA

General Provider Information

NPI Number	:	1811335342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA S STANLEY MOT, OTR/L

Provider Business Mailing Address
First Line	:	300 WESTWOOD CIR
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30721-8356
Country	:	US
Telephone Number	:	706-483-1440
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 WESTWOOD CIR
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30721-8356
Country	:	US
Telephone Number	:	706-483-1440
Fax Number	:

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

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	08/30/2015

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