Provider Demographics
NPI:1063552933
Name:REBUCK, JOANN MAE (COTA)
Entity type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:MAE
Last Name:REBUCK
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 284
Mailing Address - Street 2:
Mailing Address - City:FORT LOUDON
Mailing Address - State:PA
Mailing Address - Zip Code:17224-0284
Mailing Address - Country:US
Mailing Address - Phone:717-369-4050
Mailing Address - Fax:
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:CHAMBERSBURG HOSPITAL-PHYSICAL MEDICINE DEPARTMENT
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-267-7708
Practice Address - Fax:717-267-7463
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002721L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant