Provider Demographics
NPI:1477062354
Name:WILSON, REBEKAH ANNE (COTA)
Entity type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:ANNE
Last Name:WILSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4062 SUMMERHILL SQ
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2730
Mailing Address - Country:US
Mailing Address - Phone:903-908-3839
Mailing Address - Fax:844-228-2099
Practice Address - Street 1:3223 SPRING CYPRESS RD APT 635
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4897
Practice Address - Country:US
Practice Address - Phone:903-754-9009
Practice Address - Fax:844-228-2099
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-24
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214633224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant