Provider Demographics
NPI:1710163761
Name:ANDERSON, REBECCA M (OTR)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:WIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6840 EMERALD BAY LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-5063
Mailing Address - Country:US
Mailing Address - Phone:317-501-6749
Mailing Address - Fax:
Practice Address - Street 1:3077 E 98TH ST
Practice Address - Street 2:SUITE 265
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2940
Practice Address - Country:US
Practice Address - Phone:866-855-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-20
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004134A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist