Provider Demographics
NPI:1871527580
Name:DIPASQUALE, REBECCA (MSOTRL)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DIPASQUALE
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2142
Mailing Address - Country:US
Mailing Address - Phone:570-759-6883
Mailing Address - Fax:
Practice Address - Street 1:1 W BROAD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6407
Practice Address - Country:US
Practice Address - Phone:570-459-4559
Practice Address - Fax:570-459-4558
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004381L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019213540007-0008Medicaid
PA0019213540007-0008Medicaid