Provider Demographics
NPI:1295905701
Name:THOMAS, REBECCA BURNETTE (MOT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:BURNETTE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-4611
Mailing Address - Country:US
Mailing Address - Phone:901-734-6411
Mailing Address - Fax:901-747-1801
Practice Address - Street 1:100 N HUMPHREYS BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2146
Practice Address - Country:US
Practice Address - Phone:901-747-1800
Practice Address - Fax:901-747-1801
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000001418225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics