Provider Demographics
NPI:1407076367
Name:HORNBERGER, REBECCA J (OTR)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:HORNBERGER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23404 LAKE TAMBO RD
Mailing Address - Street 2:
Mailing Address - City:SUNMAN
Mailing Address - State:IN
Mailing Address - Zip Code:47041-7558
Mailing Address - Country:US
Mailing Address - Phone:812-623-1139
Mailing Address - Fax:812-623-1139
Practice Address - Street 1:23404 LAKE TAMBO RD
Practice Address - Street 2:
Practice Address - City:SUNMAN
Practice Address - State:IN
Practice Address - Zip Code:47041-7558
Practice Address - Country:US
Practice Address - Phone:812-623-1139
Practice Address - Fax:812-623-1139
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003297A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist