Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC008944 | PA |
NPI | 1003014317 |
---|---|
Provider Name | Rebecca Ebbert |
First Address | Palmerton, PA 18071-1603 |
Second Address | Phoenix, AZ 85021-7967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2007 |
Last Update Date | 08/07/2007 |