Provider Demographics
NPI:1184329971
Name:NOVAK, REBECCA ASHTON (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:ASHTON
Last Name:NOVAK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HADLEY PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-2022
Mailing Address - Country:US
Mailing Address - Phone:757-812-1193
Mailing Address - Fax:
Practice Address - Street 1:955 HARPERSVILLE RD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1085
Practice Address - Country:US
Practice Address - Phone:757-223-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002295224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant