Provider Demographics
NPI:1871032482
Name:SMITH, REBECCA LYNN
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:SMITH
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:RR 1 BOX 295
Mailing Address - Street 2:
Mailing Address - City:TERLTON
Mailing Address - State:OK
Mailing Address - Zip Code:74081-9723
Mailing Address - Country:US
Mailing Address - Phone:918-381-7863
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 295
Practice Address - Street 2:
Practice Address - City:TERLTON
Practice Address - State:OK
Practice Address - Zip Code:74081-9723
Practice Address - Country:US
Practice Address - Phone:918-381-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator