Provider Demographics
NPI:1942645072
Name:COCKLEREECE, REBECCA MICHELLE (LMP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MICHELLE
Last Name:COCKLEREECE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28719 W LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FORD
Mailing Address - State:WA
Mailing Address - Zip Code:99013-9502
Mailing Address - Country:US
Mailing Address - Phone:509-868-6256
Mailing Address - Fax:
Practice Address - Street 1:13701 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0811
Practice Address - Country:US
Practice Address - Phone:509-922-5585
Practice Address - Fax:509-927-7336
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019356225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist