Provider Demographics
NPI:1700052479
Name:WITHERS, REBECCA LEA (HSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEA
Last Name:WITHERS
Suffix:
Gender:F
Credentials:HSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LEA
Other - Last Name:NEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HSW
Mailing Address - Street 1:1221 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1745
Mailing Address - Country:US
Mailing Address - Phone:208-255-7337
Mailing Address - Fax:208-561-9705
Practice Address - Street 1:110 TIBBETTS DR
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-9812
Practice Address - Country:US
Practice Address - Phone:208-255-7337
Practice Address - Fax:208-561-9705
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTA-1794224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant