Provider Demographics
NPI:1114161577
Name:RODE, REBECCA HOWARD (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:HOWARD
Last Name:RODE
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7818 BIG SKY DR
Mailing Address - Street 2:STE 217
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2840
Mailing Address - Country:US
Mailing Address - Phone:219-588-8275
Mailing Address - Fax:608-709-7071
Practice Address - Street 1:704 S ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1782
Practice Address - Country:US
Practice Address - Phone:309-944-3072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002003225X00000X
IN31003637A225X00000X
WI6646-26225X00000X
IL056007579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist