Provider Demographics
NPI:1609966480
Name:BECKER, RUSTY G (OTR/L)
Entity Type:Individual
Prefix:
First Name:RUSTY
Middle Name:G
Last Name:BECKER
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 1:399 MOUNTAIN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-2128
Mailing Address - Country:US
Mailing Address - Phone:334-285-7101
Mailing Address - Fax:
Practice Address - Street 1:340 MENDEL PKWY W
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-5406
Practice Address - Country:US
Practice Address - Phone:334-532-0220
Practice Address - Fax:334-532-0221
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2334225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890015790Medicaid
AL24EX37RHOtherBCBS PHYS NUMBER