Provider Demographics
NPI:1811335342
Name:STANLEY, REBECCA S (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WESTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-8356
Mailing Address - Country:US
Mailing Address - Phone:706-483-1440
Mailing Address - Fax:
Practice Address - Street 1:300 WESTWOOD CIR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8356
Practice Address - Country:US
Practice Address - Phone:706-483-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005560225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist