Healthcare Provider Details

I. General information

NPI: 1194946657
Provider Name (Legal Business Name): REBECCA ANN KENDRICK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8507 NE 8TH WAY
VANCOUVER WA
98664-1980
US

IV. Provider business mailing address

1309 NE 145TH AVE
VANCOUVER WA
98684-7978
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-5335
  • Fax: 360-892-2086
Mailing address:
  • Phone: 360-256-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00003817
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: