Provider Demographics
NPI:1689841892
Name:GUSTIN, REBEKAH R (OT)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:R
Last Name:GUSTIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:R
Other - Last Name:REISWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1012 SOUTH THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328
Mailing Address - Country:US
Mailing Address - Phone:509-382-3202
Mailing Address - Fax:509-382-3209
Practice Address - Street 1:1012 SOUTH THIRD STREET
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328
Practice Address - Country:US
Practice Address - Phone:509-382-3202
Practice Address - Fax:509-382-3209
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002246225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist