Provider Demographics
NPI:1265084388
Name:FISCAL, REBECCA KRAMER (OTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KRAMER
Last Name:FISCAL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 STRATFORD GRN
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-1355
Mailing Address - Country:US
Mailing Address - Phone:404-782-8647
Mailing Address - Fax:
Practice Address - Street 1:650 HAMILTON AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3778
Practice Address - Country:US
Practice Address - Phone:404-782-8647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006887225X00000X
GA006887225X00000X
006887225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist