Provider Demographics
NPI:1689021156
Name:REBECCA O'BRYAN THERAPY SERVICES
Entity Type:Organization
Organization Name:REBECCA O'BRYAN THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DEVELOPMENTAL INTERVENTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-791-0866
Mailing Address - Street 1:1164 ANTIOCH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ALVATON
Mailing Address - State:KY
Mailing Address - Zip Code:42122-9502
Mailing Address - Country:US
Mailing Address - Phone:270-791-0866
Mailing Address - Fax:
Practice Address - Street 1:1164 ANTIOCH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ALVATON
Practice Address - State:KY
Practice Address - Zip Code:42122-9502
Practice Address - Country:US
Practice Address - Phone:270-791-0866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency