Provider Demographics
NPI:1346406055
Name:WRIGHT, REBECCA JANE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:WRIGHT
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 1:119 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17222-1109
Mailing Address - Country:US
Mailing Address - Phone:717-808-6854
Mailing Address - Fax:
Practice Address - Street 1:321 NORRISTOWN RD STE 200
Practice Address - Street 2:SUPPLEMENTAL HEALTH CARE
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2793
Practice Address - Country:US
Practice Address - Phone:215-646-5400
Practice Address - Fax:215-646-5401
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002436L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant