Provider Demographics
NPI:1295340214
Name:LANGE, REBECCA (OTR)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:LANGE
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 1:9638 W BUTLER DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7711
Mailing Address - Country:US
Mailing Address - Phone:608-206-4387
Mailing Address - Fax:
Practice Address - Street 1:9638 W BUTLER DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7711
Practice Address - Country:US
Practice Address - Phone:608-206-4387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-006608225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist