Provider Demographics
NPI:1194180778
Name:BOKAT, REBECCA SUZANNE (MS, RD, LDN, CEDRD)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUZANNE
Last Name:BOKAT
Suffix:
Gender:F
Credentials:MS, RD, LDN, CEDRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OCEAN AVE UNIT 655
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1445
Mailing Address - Country:US
Mailing Address - Phone:617-383-7137
Mailing Address - Fax:
Practice Address - Street 1:500 OCEAN AVE UNIT 655
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-1445
Practice Address - Country:US
Practice Address - Phone:617-383-7137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2877133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered