Provider Demographics
NPI:1689008088
Name:ALLEN, REBECCA (MS OTR/L)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 HIDDEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1113
Mailing Address - Country:US
Mailing Address - Phone:703-929-6557
Mailing Address - Fax:
Practice Address - Street 1:3422 HIDDEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1113
Practice Address - Country:US
Practice Address - Phone:703-929-6557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005927225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist