Provider Demographics
NPI:1700207719
Name:STOTT, REBECCA (LAC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:STOTT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3003
Mailing Address - Country:US
Mailing Address - Phone:802-258-7798
Mailing Address - Fax:
Practice Address - Street 1:1523 E MADISON ST
Practice Address - Street 2:RM 7
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4013
Practice Address - Country:US
Practice Address - Phone:802-258-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60338512171100000X
VT091.0045903171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist