Provider Demographics
NPI:1437546710
Name:MASK, REBECA (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:
Last Name:MASK
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:REBECA
Other - Middle Name:
Other - Last Name:CHERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:1301 1ST ST SW APT 1
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-0337
Mailing Address - Country:US
Mailing Address - Phone:507-358-4852
Mailing Address - Fax:
Practice Address - Street 1:150 MUIR RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4668
Practice Address - Country:US
Practice Address - Phone:800-382-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13770225X00000X
MN104366225X00000X
CO0003986225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist