Provider Demographics
NPI:1902661952
Name:LOVELAND, REBECCA LYNN (COTA/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:LOVELAND
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S PARKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-4222
Mailing Address - Country:US
Mailing Address - Phone:417-231-2592
Mailing Address - Fax:
Practice Address - Street 1:100 N MAPLE LN
Practice Address - Street 2:
Practice Address - City:ASH GROVE
Practice Address - State:MO
Practice Address - Zip Code:65604-9112
Practice Address - Country:US
Practice Address - Phone:417-751-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019045726224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant