Provider Demographics
NPI:1841854809
Name:MEBANE, REBECCA DIANE (COTA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DIANE
Last Name:MEBANE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:TARZAN
Mailing Address - State:TX
Mailing Address - Zip Code:79783-0061
Mailing Address - Country:US
Mailing Address - Phone:806-893-0436
Mailing Address - Fax:
Practice Address - Street 1:1809 N US HIGHWAY 87
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-0793
Practice Address - Country:US
Practice Address - Phone:432-268-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215666224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant