Provider Demographics
NPI:1588903280
Name:LUNDQUIST, REBECCA MARIE
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MARIE
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10830 E AZALEA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-8626
Mailing Address - Country:US
Mailing Address - Phone:480-570-6390
Mailing Address - Fax:
Practice Address - Street 1:1355 S HIGLEY RD
Practice Address - Street 2:BUILDING 5, SUITE 111
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4799
Practice Address - Country:US
Practice Address - Phone:480-474-4173
Practice Address - Fax:480-237-9727
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant