Provider Demographics
NPI:1841451507
Name:HERNDON, REBECCA M (MSOTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:HERNDON
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:FIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR/L
Mailing Address - Street 1:325 US-1
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-9223
Mailing Address - Country:US
Mailing Address - Phone:207-781-2741
Mailing Address - Fax:
Practice Address - Street 1:325 US-1
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105
Practice Address - Country:US
Practice Address - Phone:207-781-2741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2415225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist