Provider Demographics
NPI:1053681692
Name:SOKEL, REBEKAH (COTA)
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:
Last Name:SOKEL
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 1:2961 SAINT ANTHONY DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5860
Mailing Address - Country:US
Mailing Address - Phone:920-468-0861
Mailing Address - Fax:920-468-5689
Practice Address - Street 1:2961 SAINT ANTHONY DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5860
Practice Address - Country:US
Practice Address - Phone:920-468-0861
Practice Address - Fax:920-468-5689
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4631-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1053681692Medicaid