Provider Demographics
NPI:1508021379
Name:KLOBERDANZ, REBECCA L (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:L
Last Name:KLOBERDANZ
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:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-0817
Mailing Address - Country:US
Mailing Address - Phone:206-399-3553
Mailing Address - Fax:
Practice Address - Street 1:20800 OLD MILL RD SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-6459
Practice Address - Country:US
Practice Address - Phone:206-399-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT007005225X00000X
WAOT00003355225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist