Provider Demographics
NPI:1134568629
Name:MOYER, REBECCA IRENE (OTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:IRENE
Last Name:MOYER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:IRENE
Other - Last Name:POLANSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2198 NE STEPHENS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1410
Mailing Address - Country:US
Mailing Address - Phone:541-900-1418
Mailing Address - Fax:541-900-1419
Practice Address - Street 1:2198 NE STEPHENS ST STE 101
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1410
Practice Address - Country:US
Practice Address - Phone:541-900-1418
Practice Address - Fax:541-900-1419
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115666225X00000X
MN104482225X00000X
OR311044225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist