Provider Demographics
NPI:1992269948
Name:DANIELS, REBECCA MARCIA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARCIA
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 HIGHOAKS CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-6758
Mailing Address - Country:US
Mailing Address - Phone:917-653-1540
Mailing Address - Fax:
Practice Address - Street 1:4650 GLENFOREST DR NE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5714
Practice Address - Country:US
Practice Address - Phone:917-653-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003545225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT003545OtherGA OT LICENSE