Provider Demographics
NPI:1013275064
Name:KODIS, REBECCA ELISABETH (OTR)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ELISABETH
Last Name:KODIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1030
Mailing Address - Country:US
Mailing Address - Phone:802-379-1874
Mailing Address - Fax:
Practice Address - Street 1:11 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1030
Practice Address - Country:US
Practice Address - Phone:802-379-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0720000174225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics