Provider Demographics
NPI:1871953588
Name:CARDELL, REBECCA CHRISTON (OTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:CHRISTON
Last Name:CARDELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-1020
Mailing Address - Country:US
Mailing Address - Phone:770-617-6553
Mailing Address - Fax:
Practice Address - Street 1:200 ROCKAWAY RD
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-2511
Practice Address - Country:US
Practice Address - Phone:470-278-2254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004090225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist