Provider Demographics
NPI:1588019970
Name:MARUSHACK, REBECCA ANN (MOTR/L- CLT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:MARUSHACK
Suffix:
Gender:F
Credentials:MOTR/L- CLT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L- CLT
Mailing Address - Street 1:1844 CONCORD HILL DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1917 ABBOTT RD STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3449
Practice Address - Country:US
Practice Address - Phone:907-279-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101238225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist