Provider Demographics
NPI:1760758635
Name:SPANG, REBECCA KEIL (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:KEIL
Last Name:SPANG
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6912 220TH ST SW STE 213
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2171
Mailing Address - Country:US
Mailing Address - Phone:425-672-2716
Mailing Address - Fax:
Practice Address - Street 1:6912 220TH ST SW STE 213
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2171
Practice Address - Country:US
Practice Address - Phone:425-672-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00002692225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist