Provider Demographics
NPI:1467713040
Name:TRUCKS, MARY REBEKAH (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:MARY REBEKAH
Middle Name:
Last Name:TRUCKS
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 1:1244 DUNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2124
Mailing Address - Country:US
Mailing Address - Phone:205-223-1605
Mailing Address - Fax:205-975-2380
Practice Address - Street 1:1244 DUNSTON AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-2124
Practice Address - Country:US
Practice Address - Phone:205-223-1605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2003225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics