Provider Demographics
NPI:1326583444
Name:AVANTS, REBECCA
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:AVANTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3021
Mailing Address - Country:US
Mailing Address - Phone:580-290-5144
Mailing Address - Fax:580-290-5145
Practice Address - Street 1:1611 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3021
Practice Address - Country:US
Practice Address - Phone:580-290-5144
Practice Address - Fax:580-290-5145
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1147237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist