Provider Demographics
NPI:1750533097
Name:MIKSIC, REBECCA (OTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MIKSIC
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 1:9929 MAYA LINDA RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4141
Mailing Address - Country:US
Mailing Address - Phone:619-846-1196
Mailing Address - Fax:
Practice Address - Street 1:10225 BARNES CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2734
Practice Address - Country:US
Practice Address - Phone:619-846-1196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5603174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist