Provider Demographics
NPI:1407326184
Name:DIETLY, REBECCA FAITH (OTR)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:FAITH
Last Name:DIETLY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:123 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2100
Mailing Address - Country:US
Mailing Address - Phone:863-471-6303
Mailing Address - Fax:863-471-1251
Practice Address - Street 1:250 3RD ST NW STE 202
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4605
Practice Address - Country:US
Practice Address - Phone:863-662-3935
Practice Address - Fax:863-662-3936
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19598225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist