Provider Demographics
NPI:1346529708
Name:ICE, REBEKAH DIANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:DIANE
Last Name:ICE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 SW 93RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7112
Mailing Address - Country:US
Mailing Address - Phone:405-919-9025
Mailing Address - Fax:
Practice Address - Street 1:1604 SW 93RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7112
Practice Address - Country:US
Practice Address - Phone:405-919-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1613225X00000X
IL056.008779225X00000X
CO3049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist