Provider Demographics
NPI:1174232979
Name:CAPITAO, REBECCA LYNNE (OTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:CAPITAO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNNE
Other - Last Name:CPDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:BAUSMAN
Mailing Address - State:PA
Mailing Address - Zip Code:17504-0148
Mailing Address - Country:US
Mailing Address - Phone:717-224-5682
Mailing Address - Fax:
Practice Address - Street 1:99 BETHANY RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9525
Practice Address - Country:US
Practice Address - Phone:717-738-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017511225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist