Provider Demographics
NPI:1588345193
Name:STOTZ, REBECCA LOUISE (COTA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LOUISE
Last Name:STOTZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 LINDY LN NE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-1910
Mailing Address - Country:US
Mailing Address - Phone:507-215-5455
Mailing Address - Fax:
Practice Address - Street 1:1555 SHERWOOD ST SE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3285
Practice Address - Country:US
Practice Address - Phone:320-484-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN201966224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant