Provider Demographics
NPI:1639155344
Name:HARROLD, REBECCA L (OTR/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:HARROLD
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 1:1619 NW HAWTHORNE AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-6008
Mailing Address - Country:US
Mailing Address - Phone:541-476-2502
Mailing Address - Fax:541-476-2397
Practice Address - Street 1:1619 NW HAWTHORNE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-6008
Practice Address - Country:US
Practice Address - Phone:541-476-2502
Practice Address - Fax:541-476-2397
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR991715225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR123534Medicaid
ORR102653OtherGROUP MEDICARE
OR123534Medicaid