Provider Demographics
NPI:1982091757
Name:ANTOSZ, REBECCA MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:ANTOSZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 ELM ST APT 3
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01038-9715
Mailing Address - Country:US
Mailing Address - Phone:413-965-7107
Mailing Address - Fax:
Practice Address - Street 1:87 ELM ST APT 3
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:MA
Practice Address - Zip Code:01038-9715
Practice Address - Country:US
Practice Address - Phone:413-965-7107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3301224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant