Provider Demographics
NPI:1538981634
Name:SORENSEN, REBECCA (COTA/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:2878 E SILVERSMITH TRL
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-3314
Mailing Address - Country:US
Mailing Address - Phone:217-503-6868
Mailing Address - Fax:
Practice Address - Street 1:510 E 8TH ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4072
Practice Address - Country:US
Practice Address - Phone:520-413-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-046607225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist