Provider Demographics
NPI:1942053186
Name:LAURITZEN, REBECCA S
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:LAURITZEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4797 REX CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-1821
Mailing Address - Country:US
Mailing Address - Phone:435-592-1632
Mailing Address - Fax:
Practice Address - Street 1:2345 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4708
Practice Address - Country:US
Practice Address - Phone:916-480-6735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60634374225X00000X
CA27291225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist