Provider Demographics
NPI:1790036358
Name:OOSTERHOUT, REBECCA ANN (MS, RD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:OOSTERHOUT
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23745 225TH WAY SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5294
Mailing Address - Country:US
Mailing Address - Phone:855-287-8348
Mailing Address - Fax:
Practice Address - Street 1:23745 225TH WAY SE
Practice Address - Street 2:SUITE 201
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5294
Practice Address - Country:US
Practice Address - Phone:855-287-8348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI-60312517133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered