MEDICARE: DR. REBECCA ELLEN OSTERHOUT PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OH12447	OTHER	MI	BCBSM PIN

General Provider Information

NPI Number	:	1417281072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA ELLEN OSTERHOUT PHD

Provider Business Mailing Address
First Line	:	2395 OAK VALLEY DR
Second Line	:	SUITE 100
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9118
Country	:	US
Telephone Number	:	607-725-6870
Fax Number	:

Provider Business Practice Location Address
First Line	:	2395 OAK VALLEY DR
Second Line	:	SUITE 100
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9118
Country	:	US
Telephone Number	:	607-725-6870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	08/26/2016

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