Provider Demographics
NPI:1720315591
Name:FABIANICH, REBECCA YVONNE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:YVONNE
Last Name:FABIANICH
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 1:817 7TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-7811
Mailing Address - Country:US
Mailing Address - Phone:330-837-5435
Mailing Address - Fax:
Practice Address - Street 1:817 7TH ST SW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-7811
Practice Address - Country:US
Practice Address - Phone:330-837-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-15
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA 00891224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant