Basic Information
Provider Information
NPI: 1255648762
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOSTER
FirstName: REBECCA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5020
Address2:  
City: MINOT
State: ND
PostalCode: 587025020
CountryCode: US
TelephoneNumber: 7018575105
FaxNumber: 7018575646
Practice Location
Address1: 101 3RD AVE SW
Address2:  
City: MINOT
State: ND
PostalCode: 587013880
CountryCode: US
TelephoneNumber: 7018575286
FaxNumber: 7018575694
Other Information
ProviderEnumerationDate: 09/03/2010
LastUpdateDate: 09/03/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X1075NDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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