Provider Demographics
NPI:1659863488
Name:MCCLELLAN, REBECCA NICOLE (MA, OTR/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:NICOLE
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:NICOLE
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5406 MERLE HAY RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1209
Mailing Address - Country:US
Mailing Address - Phone:515-727-8750
Mailing Address - Fax:515-727-8757
Practice Address - Street 1:5406 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1209
Practice Address - Country:US
Practice Address - Phone:515-727-8750
Practice Address - Fax:515-727-8757
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095084225X00000X
MN105649225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNJZQ128135634001OtherBLUE CROSS BLUE SHIELD