Provider Demographics
NPI:1972014686
Name:FOX, REBEKAH MOHEAD
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:MOHEAD
Last Name:FOX
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 1:1101 OHIO DR STE 105
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5331
Mailing Address - Country:US
Mailing Address - Phone:972-599-9594
Mailing Address - Fax:972-599-9364
Practice Address - Street 1:1101 OHIO DR STE 105
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5331
Practice Address - Country:US
Practice Address - Phone:972-599-9594
Practice Address - Fax:972-599-9364
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104405225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104405OtherOCCUPATIONAL THERAPY LICENSE