Provider Demographics
NPI:1912495755
Name:HARRIS, REBEKA
Entity Type:Individual
Prefix:
First Name:REBEKA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 FM 400
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:TX
Mailing Address - Zip Code:79381-2002
Mailing Address - Country:US
Mailing Address - Phone:806-252-7021
Mailing Address - Fax:
Practice Address - Street 1:701 CAMINO DEL RIO STE 221
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5466
Practice Address - Country:US
Practice Address - Phone:970-247-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119079225X00000X
225X00000X
COOT.0007613225X00000X
NMOT-2023-0152225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist