Provider Demographics
NPI:1235801127
Name:TOMCZYK, REBECKA MICHELLE (COTA)
Entity Type:Individual
Prefix:
First Name:REBECKA
Middle Name:MICHELLE
Last Name:TOMCZYK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:REBECKA
Other - Middle Name:MICHELLE
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:5323 TOWER HL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-6361
Mailing Address - Country:US
Mailing Address - Phone:757-746-7504
Mailing Address - Fax:
Practice Address - Street 1:440 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6330
Practice Address - Country:US
Practice Address - Phone:757-221-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001779224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant