Provider Demographics
NPI:1437835691
Name:BEADLES, REBECCA (OT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BEADLES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:7318 93RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4938
Mailing Address - Country:US
Mailing Address - Phone:806-632-5672
Mailing Address - Fax:
Practice Address - Street 1:7318 93RD ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-4938
Practice Address - Country:US
Practice Address - Phone:806-632-5672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112544225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist