Provider Demographics
NPI:1992821250
Name:REILLY, REBECCA (OTR)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:REILLY
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 1:275 DREHERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ORWIGSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17961-9603
Mailing Address - Country:US
Mailing Address - Phone:570-366-1892
Mailing Address - Fax:570-366-1623
Practice Address - Street 1:1000 SETON DR
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-1009
Practice Address - Country:US
Practice Address - Phone:570-366-1941
Practice Address - Fax:570-366-7642
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009761225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist