Provider Demographics
NPI:1811523244
Name:PILGRIM, REBECCA DARLENE (COTA)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DARLENE
Last Name:PILGRIM
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:BECKY
Other - Middle Name:D
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:902 N GREGG RD
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-1169
Mailing Address - Country:US
Mailing Address - Phone:765-265-1937
Mailing Address - Fax:
Practice Address - Street 1:902 N GREGG RD
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-1169
Practice Address - Country:US
Practice Address - Phone:765-265-1937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002017A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant