Provider Demographics
NPI:1952661266
Name:MCBRIDE, REBECCA (OT/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:LUSK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT/L
Mailing Address - Street 1:1201 BURLEYSON RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3019
Mailing Address - Country:US
Mailing Address - Phone:706-226-8900
Mailing Address - Fax:706-226-8905
Practice Address - Street 1:1201 BURLEYSON RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3019
Practice Address - Country:US
Practice Address - Phone:706-226-8900
Practice Address - Fax:706-226-8905
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000000933225XP0200X
GAOT003134225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN933OtherTN HEALTH LICENSE