Provider Demographics
NPI:1760816466
Name:BANKS, REBECCA J (COTA)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:J
Last Name:BANKS
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 1:302 E BURDICK AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2732
Mailing Address - Country:US
Mailing Address - Phone:414-469-1450
Mailing Address - Fax:414-481-3334
Practice Address - Street 1:302 E BURDICK AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-2732
Practice Address - Country:US
Practice Address - Phone:414-469-1450
Practice Address - Fax:414-481-3334
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI681-27224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification