Provider Demographics
NPI:1235686700
Name:BROCK, REBECCA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3877 COPPER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-1168
Mailing Address - Country:US
Mailing Address - Phone:513-284-9539
Mailing Address - Fax:
Practice Address - Street 1:2400 CLERMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1990
Practice Address - Country:US
Practice Address - Phone:513-735-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006948225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics