Provider Demographics
NPI:1679775258
Name:DICK, REBECCA WEST (OTA/L)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:WEST
Last Name:DICK
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-1519
Mailing Address - Country:US
Mailing Address - Phone:207-446-9345
Mailing Address - Fax:
Practice Address - Street 1:41 HEATH ST
Practice Address - Street 2:SPED OFFICE RSU #18 ,
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-4901
Practice Address - Country:US
Practice Address - Phone:207-465-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA305224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant