Provider Demographics
NPI:1760243638
Name:SCHADOFF, REBECCA DYLAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DYLAN
Last Name:SCHADOFF
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 1:2058 BLAKERS BLVD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7853
Mailing Address - Country:US
Mailing Address - Phone:631-275-1545
Mailing Address - Fax:
Practice Address - Street 1:5105 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4621
Practice Address - Country:US
Practice Address - Phone:912-356-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6614225X00000X
GAOT008589225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist