Provider Demographics
NPI:1114343605
Name:BEDARD, REBECCA JANE (ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:BEDARD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 PIEDMONT AVE NE APT C4
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3732
Mailing Address - Country:US
Mailing Address - Phone:413-237-0665
Mailing Address - Fax:
Practice Address - Street 1:59 EXECUTIVE PARK S
Practice Address - Street 2:SUITE 1000
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2208
Practice Address - Country:US
Practice Address - Phone:404-778-7137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-09
Last Update Date:2014-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2000001376246Z00000X
NY13-0618246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other