Provider Demographics
NPI:1851759773
Name:FICK, REBECCA (ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:FICK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 RIVER HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-8830
Mailing Address - Country:US
Mailing Address - Phone:360-269-3344
Mailing Address - Fax:
Practice Address - Street 1:605 CENTER RD
Practice Address - Street 2:APARTMENT E108
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-7893
Practice Address - Country:US
Practice Address - Phone:360-269-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1 603011542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer