Provider Demographics
NPI:1730475369
Name:SMITH, REBECCA A (SPEECH THERAPIST)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 SHERRILL RD
Mailing Address - Street 2:
Mailing Address - City:SHERRILL
Mailing Address - State:NY
Mailing Address - Zip Code:13461-1226
Mailing Address - Country:US
Mailing Address - Phone:315-982-0476
Mailing Address - Fax:
Practice Address - Street 1:423 SHERRILL RD
Practice Address - Street 2:
Practice Address - City:SHERRILL
Practice Address - State:NY
Practice Address - Zip Code:13461-1226
Practice Address - Country:US
Practice Address - Phone:315-982-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY873743251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)