Basic Information
| Provider Information | |||||||||
| NPI: | 1972719326 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAFFORD | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | LORRAINE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1608 PEARL ST | ||||||||
| Address2: | |||||||||
| City: | ELDORADO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315815025 | ||||||||
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| Practice Location | |||||||||
| Address1: | 252 W. FIFTH ST. | ||||||||
| Address2: | |||||||||
| City: | LACENTER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420560269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706655681 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | KY-A2497 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.