Provider Demographics
NPI:1558993782
Name:SNYDER, REBECCA SARA (OTR/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SARA
Last Name:SNYDER
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 1:34 BARCELONA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5318
Mailing Address - Country:US
Mailing Address - Phone:949-290-9193
Mailing Address - Fax:
Practice Address - Street 1:17861 VON KARMAN AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6213
Practice Address - Country:US
Practice Address - Phone:949-222-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20769225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist