Provider Demographics
NPI:1760263297
Name:WHALEN, REBECCA ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:WHALEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:SCHOMBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:565 CHICAGO DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1725
Mailing Address - Country:US
Mailing Address - Phone:734-502-7495
Mailing Address - Fax:
Practice Address - Street 1:2830 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5806
Practice Address - Country:US
Practice Address - Phone:734-359-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202003885224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant