Provider Demographics
NPI:1285028845
Name:KONKLE, REBEKAH EDITH (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:EDITH
Last Name:KONKLE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:EDITH
Other - Last Name:BEZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:P.O. BOX 1091
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37816
Mailing Address - Country:US
Mailing Address - Phone:423-254-1978
Mailing Address - Fax:423-289-1072
Practice Address - Street 1:900 TRADE ST.
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813
Practice Address - Country:US
Practice Address - Phone:423-254-1978
Practice Address - Fax:423-289-1072
Is Sole Proprietor?:No
Enumeration Date:2015-03-22
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5173225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ018282Medicaid