Provider Demographics
NPI:1932870862
Name:EIDE, REBEKAH GRACE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:GRACE
Last Name:EIDE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:511 3RD AVE S APT 9
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57226-2050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:803 PART ST
Practice Address - Street 2:
Practice Address - City:LAKE NORDEN
Practice Address - State:SD
Practice Address - Zip Code:57248
Practice Address - Country:US
Practice Address - Phone:605-785-3654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant