Provider Demographics
NPI:1457026064
Name:VASTA, REBECCA ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:VASTA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13117 3RD AVE SE UNIT K4
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6671
Mailing Address - Country:US
Mailing Address - Phone:214-385-1876
Mailing Address - Fax:
Practice Address - Street 1:2205 N 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6903
Practice Address - Country:US
Practice Address - Phone:206-604-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61546148225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist