Provider Demographics
NPI:1992402010
Name:RASOR, MARY REBECCA FAIRBANKS (COTA/L)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:REBECCA FAIRBANKS
Last Name:RASOR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:REBECCA
Other - Last Name:FAIRBANKS RASOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:150 PINEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4921
Mailing Address - Country:US
Mailing Address - Phone:201-681-8233
Mailing Address - Fax:
Practice Address - Street 1:33 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1401
Practice Address - Country:US
Practice Address - Phone:201-632-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09231000224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty