Provider Demographics
NPI:1154516805
Name:FAIRFAX, REBECCA JOANNE (OTR L)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JOANNE
Last Name:FAIRFAX
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:JOANNE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:15021 N MAPLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268
Mailing Address - Country:US
Mailing Address - Phone:480-686-8801
Mailing Address - Fax:
Practice Address - Street 1:8125 N 23RD AVE
Practice Address - Street 2:SUITE 221
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021
Practice Address - Country:US
Practice Address - Phone:602-443-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1331225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist