Provider Demographics
NPI:1245369610
Name:SALAS, REBECCA (OTR)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:SALAS
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 1:11725 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1773
Mailing Address - Country:US
Mailing Address - Phone:480-298-1762
Mailing Address - Fax:
Practice Address - Street 1:32531 N SCOTTSDALE RD
Practice Address - Street 2:STE. 105-162
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-1519
Practice Address - Country:US
Practice Address - Phone:480-488-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3756225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ119058Medicaid