Provider Demographics
NPI:1831215565
Name:MCVAUGH, REBECCA ELAINE (OTRL)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELAINE
Last Name:MCVAUGH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2910
Mailing Address - Country:US
Mailing Address - Phone:717-652-1812
Mailing Address - Fax:
Practice Address - Street 1:4918 CREEK DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2910
Practice Address - Country:US
Practice Address - Phone:717-652-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009946225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101542800 0001Medicare ID - Type Unspecified