Provider Demographics
NPI:1790928323
Name:KING, REBECCA N (OTR)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:N
Last Name:KING
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:N
Other - Last Name:BUMGARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:11556 E D AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083
Mailing Address - Country:US
Mailing Address - Phone:269-629-5304
Mailing Address - Fax:
Practice Address - Street 1:111 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49037
Practice Address - Country:US
Practice Address - Phone:269-969-6110
Practice Address - Fax:269-969-6120
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002577225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist