Provider Demographics
NPI:1376169078
Name:HENDERSON, REBECCA SUE (CRT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:SUE
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 W WILSHIRE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7702
Mailing Address - Country:US
Mailing Address - Phone:405-840-5272
Mailing Address - Fax:405-840-5274
Practice Address - Street 1:415 W WILSHIRE BLVD STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7702
Practice Address - Country:US
Practice Address - Phone:405-840-5272
Practice Address - Fax:405-840-5274
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2059227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified