Provider Demographics
NPI:1871701136
Name:STANISLAW, REBECCA JEAN (COTA)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JEAN
Last Name:STANISLAW
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 89176
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85752-9176
Mailing Address - Country:US
Mailing Address - Phone:520-219-9008
Mailing Address - Fax:
Practice Address - Street 1:1313 W MAGEE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3326
Practice Address - Country:US
Practice Address - Phone:520-797-2600
Practice Address - Fax:520-797-3100
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2135224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant