Provider Demographics
NPI:1184702458
Name:O'CONNOR, REBEKAH A (MS, CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:A
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MS, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3295 LAKE SEMINOLE PL
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3781
Mailing Address - Country:US
Mailing Address - Phone:770-614-5646
Mailing Address - Fax:
Practice Address - Street 1:3295 LAKE SEMINOLE PL
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-3781
Practice Address - Country:US
Practice Address - Phone:770-614-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000937505AMedicaid
GA000937505BMedicaid