Provider Demographics
NPI:1871917443
Name:DECOSTA, REBECCA MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:DECOSTA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:NEUTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:40 FOX RUN ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039
Mailing Address - Country:US
Mailing Address - Phone:207-615-3777
Mailing Address - Fax:
Practice Address - Street 1:20 JAMESON HILL RD
Practice Address - Street 2:
Practice Address - City:OLD ORCHARD BEACH
Practice Address - State:ME
Practice Address - Zip Code:04064-1606
Practice Address - Country:US
Practice Address - Phone:207-934-2891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2836225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist