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General NPI Number Information
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NPI Number | 1134006067
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Entity Type | Individual
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Provider Name | NICOLE RENEE RUBASH OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 200 TRIANGLE SHOPPING CTR STE 270
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City | LONGVIEW
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State | WA
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Zip | 98632-4684
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Country | US
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Telephone | 360-501-3750
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Fax | 360-501-3755
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Provider Business Mailing Address
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Address Line | 142 BULLHEAD DR
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City | CASTLE ROCK
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State | WA
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Zip | 98611-8074
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Country | US
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Telephone | 360-431-4441
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | OT61256790
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT61256790
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License Number State | WA
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