Provider Demographics
NPI:1801193016
Name:SHULTZ, REBECCA P
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:P
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 PARKWAY S
Mailing Address - Street 2:PUPIL SERVICES OFFICE
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1627
Mailing Address - Country:US
Mailing Address - Phone:207-989-8636
Mailing Address - Fax:207-989-8651
Practice Address - Street 1:79 PARKWAY S
Practice Address - Street 2:PUPIL SERVICES OFFICE
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1627
Practice Address - Country:US
Practice Address - Phone:207-989-8636
Practice Address - Fax:207-989-8651
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist