Mary Rebecca Fairbanks Rasor, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

46TA09231000 Issued in NJ

Practice address

33 Central Ave
Midland Park, NJ 07432-1401

Phone

(201) 632-1900

NPI assigned

Feb 9, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Mary Rebecca Fairbanks Rasor Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1992402010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 PINEWOOD PL",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664921",
            "telephone_number": "201-681-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 CENTRAL AVE",
            "city": "MIDLAND PARK",
            "state": "NJ",
            "postal_code": "074321401",
            "telephone_number": "201-632-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RASOR",
        "first_name": "MARY",
        "middle_name": "REBECCA FAIRBANKS",
        "name_prefix": "Ms.",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-09",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": "NJ",
            "license": "46TA09231000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "FAIRBANKS RASOR",
            "middle_name": "REBECCA",
            "prefix": "MS.",
            "credential": "COTA/L",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Occupational Therapy Assistant in Midland Park, NJ
• Providers in Midland Park, NJ by specialty
• Occupational Therapy Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.