Provider Demographics
NPI:1184678385
Name:O'BRYAN, REBECCA A (OTR)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:A
Last Name:O'BRYAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DULANEY VALLEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2600
Mailing Address - Country:US
Mailing Address - Phone:410-337-4500
Mailing Address - Fax:410-339-7326
Practice Address - Street 1:3916 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6839
Practice Address - Country:US
Practice Address - Phone:540-786-3900
Practice Address - Fax:540-785-0087
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003038225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
019100G51Medicare ID - Type Unspecified