Healthcare Provider Details

I. General information

NPI: 1457026064
Provider Name (Legal Business Name): REBECCA ANN VASTA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 N 45TH ST
SEATTLE WA
98103-6903
US

IV. Provider business mailing address

13117 3RD AVE SE UNIT K4
EVERETT WA
98208-6671
US

V. Phone/Fax

Practice location:
  • Phone: 206-604-4707
  • Fax:
Mailing address:
  • Phone: 214-385-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61546148
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: