Provider Demographics
NPI:1548739808
Name:KEITH, REBECCA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:FULPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3624 E AURORA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-1758
Mailing Address - Country:US
Mailing Address - Phone:918-850-0776
Mailing Address - Fax:
Practice Address - Street 1:303 N BROADWAY
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-2605
Practice Address - Country:US
Practice Address - Phone:918-486-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist