Provider Demographics
NPI:1063846632
Name:VELLENOWETH, REBECCA NOEL (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:NOEL
Last Name:VELLENOWETH
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1909 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3107
Mailing Address - Country:US
Mailing Address - Phone:859-771-6880
Mailing Address - Fax:877-804-4492
Practice Address - Street 1:401 LEWIS HARGETT CIR STE 120
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3564
Practice Address - Country:US
Practice Address - Phone:859-475-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist