=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780922153
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REJINA ANN YAZBECK OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2013
-----------------------------------------------------
Last Update Date | 01/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 ROCKVILLE PIKE SUITE 400
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-1631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-998-6584
-----------------------------------------------------
Fax | 202-521-1808
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 HEMINGWAY DR
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14620-3311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-705-7966
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 0119005695
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 43109
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 07018
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------