Provider Demographics
NPI:1760636849
Name:ACKER, REBECCA RUTH (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:RUTH
Last Name:ACKER
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 1:122 FISH CABIN RD
Mailing Address - Street 2:
Mailing Address - City:GLEN SPEY
Mailing Address - State:NY
Mailing Address - Zip Code:12737-5728
Mailing Address - Country:US
Mailing Address - Phone:845-856-8919
Mailing Address - Fax:845-856-8919
Practice Address - Street 1:122 FISH CABIN RD
Practice Address - Street 2:
Practice Address - City:GLEN SPEY
Practice Address - State:NY
Practice Address - Zip Code:12737-5728
Practice Address - Country:US
Practice Address - Phone:845-856-8919
Practice Address - Fax:845-856-8919
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003420-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist