Provider Demographics
NPI:1902045982
Name:RUDOLPH, REBECCA SMITH (MSOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SMITH
Last Name:RUDOLPH
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Gender:F
Credentials:MSOTR/L
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Mailing Address - Street 1:401 LOCUST ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3954
Mailing Address - Country:US
Mailing Address - Phone:412-299-0704
Mailing Address - Fax:412-299-0716
Practice Address - Street 1:2853 OXFORD BLVD.
Practice Address - Street 2:SUITE 103
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-2443
Practice Address - Country:US
Practice Address - Phone:412-299-0704
Practice Address - Fax:412-299-0716
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL056.008283225X00000X
PAOC012291225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist