Provider Demographics
NPI:1790406387
Name:COTTINGHAM, REBECCA LESLIE (OTR)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LESLIE
Last Name:COTTINGHAM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PROSPECT ST STE 3C
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1634
Mailing Address - Country:US
Mailing Address - Phone:201-347-3943
Mailing Address - Fax:
Practice Address - Street 1:6 PROSPECT ST STE 3C
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1634
Practice Address - Country:US
Practice Address - Phone:201-347-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00069900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1035004OtherNATIONAL BOARD CERTIFICATION IN OT
NJ46TR00069900OtherSTATE LICENSURE