Provider Demographics
NPI:1285844431
Name:MAXWELL, REBECCA GUILLORY (OTR)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:GUILLORY
Last Name:MAXWELL
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 1:11 MERIT WOODS PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1159
Mailing Address - Country:US
Mailing Address - Phone:936-524-7776
Mailing Address - Fax:
Practice Address - Street 1:3205 W DAVIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2039
Practice Address - Country:US
Practice Address - Phone:936-521-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102207174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist