Provider Demographics
NPI:1043495211
Name:GUIDRY, REBECCA DEPAULA (OT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DEPAULA
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:DEPAULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:5600 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-1423
Practice Address - Country:US
Practice Address - Phone:954-974-7716
Practice Address - Fax:954-974-7716
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004603225X00000X
FLOT1023225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist