Provider Demographics
NPI:1225339039
Name:DAVIS, REBECCA ANN (OT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 VINE ST
Mailing Address - Street 2:ATTN: PT DEPARTMENT
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-6700
Mailing Address - Country:US
Mailing Address - Phone:870-862-1144
Mailing Address - Fax:
Practice Address - Street 1:2700 VINE ST
Practice Address - Street 2:ATTN: PT DEPARTMENT
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6700
Practice Address - Country:US
Practice Address - Phone:870-862-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR 2215225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist