Provider Demographics
NPI:1093320061
Name:COSTA, REBECCA (OTR/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:COSTA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 LITTLE WHALENECK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1222
Mailing Address - Country:US
Mailing Address - Phone:516-554-1715
Mailing Address - Fax:
Practice Address - Street 1:991 LITTLE WHALENECK RD
Practice Address - Street 2:
Practice Address - City:NORTH MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1222
Practice Address - Country:US
Practice Address - Phone:516-554-1715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024833225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist