Provider Demographics
NPI:1326173931
Name:PARKER, REBECCA (MS,OTR)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS,OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2220 BEAN CITY ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-8737
Mailing Address - Country:US
Mailing Address - Phone:920-982-1464
Mailing Address - Fax:
Practice Address - Street 1:N2220 BEAN CITY ROAD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-8737
Practice Address - Country:US
Practice Address - Phone:920-982-1464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1648-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40620700Medicaid
WIS78648Medicare UPIN