Provider Demographics
NPI:1538426747
Name:GROSS, REBECCA KAE (MS OTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAE
Last Name:GROSS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 GREACEN POINT RD
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-4609
Mailing Address - Country:US
Mailing Address - Phone:914-672-9406
Mailing Address - Fax:
Practice Address - Street 1:144 KEATING PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6145
Practice Address - Country:US
Practice Address - Phone:718-698-6661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017-117225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics