Provider Demographics
NPI:1437635695
Name:SMITH, REBECCA LEE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7106 E 151ST ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-4137
Mailing Address - Country:US
Mailing Address - Phone:918-970-2568
Mailing Address - Fax:918-970-2585
Practice Address - Street 1:7106 E 151ST ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-4137
Practice Address - Country:US
Practice Address - Phone:918-970-2568
Practice Address - Fax:918-970-2585
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator