Provider Demographics
NPI:1528710563
Name:MAYOR, REBECCA MARIE (OTA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:MAYOR
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 102ND ST E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-6427
Mailing Address - Country:US
Mailing Address - Phone:253-229-1152
Mailing Address - Fax:
Practice Address - Street 1:1413 102ND ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-6427
Practice Address - Country:US
Practice Address - Phone:253-229-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60307935224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant