Healthcare Provider Details

I. General information

NPI: 1043055056
Provider Name (Legal Business Name): REBECCA FACEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 5TH AVE STE 308
SPOKANE WA
99204-2714
US

IV. Provider business mailing address

2920 WALNUT LN
HOBART IN
46342-3844
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-2353
  • Fax:
Mailing address:
  • Phone: 219-973-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number61564562
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: