Provider Demographics
NPI:1548873219
Name:FENDRICH, REBECCA (OT R/L)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:FENDRICH
Suffix:
Gender:F
Credentials:OT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 EDISON CT APT D
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1932
Mailing Address - Country:US
Mailing Address - Phone:718-440-2226
Mailing Address - Fax:
Practice Address - Street 1:61 EDISON CT APT D
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1932
Practice Address - Country:US
Practice Address - Phone:718-440-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024555225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty