Provider Demographics
NPI:1215195037
Name:FENLASON, REBECCA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:FENLASON
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 1:188 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5928
Mailing Address - Country:US
Mailing Address - Phone:207-622-3121
Mailing Address - Fax:207-623-7666
Practice Address - Street 1:188 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5928
Practice Address - Country:US
Practice Address - Phone:207-622-3121
Practice Address - Fax:207-623-7666
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA1794224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant