Provider Demographics
NPI:1578098547
Name:PATTEN, REBECCA M (MS OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:M
Last Name:PATTEN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ELEANOR DR
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1815
Mailing Address - Country:US
Mailing Address - Phone:732-713-5039
Mailing Address - Fax:
Practice Address - Street 1:55 ELEANOR DR
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1815
Practice Address - Country:US
Practice Address - Phone:732-713-5039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00768300405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional