Provider Demographics
NPI:1770940298
Name:WELBORN, REBECCA
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:WELBORN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:LADD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1913 NE 35TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-3420
Mailing Address - Country:US
Mailing Address - Phone:580-458-8166
Mailing Address - Fax:
Practice Address - Street 1:1913 NE 35TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-3420
Practice Address - Country:US
Practice Address - Phone:580-458-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator