Provider Demographics
NPI:1124404991
Name:HENDERSON, REBECCA (OTR/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:BRUNNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4440 CARVER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5529
Mailing Address - Country:US
Mailing Address - Phone:513-791-5688
Mailing Address - Fax:
Practice Address - Street 1:4440 CARVER WOODS DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5529
Practice Address - Country:US
Practice Address - Phone:513-791-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9062225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist