Individual
REBECCA WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2314 E BUCK RD, PENNSBURG, PA 18073-2327
(215) 300-2144
Mailing address
2314 E BUCK RD, PENNSBURG, PA 18073-2327
(215) 300-2144
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OC009305
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1015190070001
LEGACY NUMBER
PA
Enumeration date
03/26/2008
Last updated
03/26/2008
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