Provider Demographics
NPI:1649924564
Name:HUSA, OLIVIA VIOLET REBSTOCK (COTA/L)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:VIOLET REBSTOCK
Last Name:HUSA
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 1:4807 W SHAWNEE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-8642
Mailing Address - Country:US
Mailing Address - Phone:509-290-1209
Mailing Address - Fax:
Practice Address - Street 1:123 W CASCADE WAY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6017
Practice Address - Country:US
Practice Address - Phone:509-290-1209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC61234257224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant