Provider Demographics
NPI:1619390382
Name:EARP, REBECCA (ATC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:EARP
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:STEARNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:UNIVERSITY OF CONNECTICUT
Mailing Address - Street 2:2095 HILLSIDE RD, U-1110
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-1110
Mailing Address - Country:US
Mailing Address - Phone:860-486-0275
Mailing Address - Fax:860-486-1123
Practice Address - Street 1:UNIVERSITY OF CONNECTICUT
Practice Address - Street 2:2095 HILLSIDE RD, U-1110
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-1110
Practice Address - Country:US
Practice Address - Phone:860-486-0275
Practice Address - Fax:860-486-1123
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0004022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer