Healthcare Provider Details

I. General information

NPI: 1659527828
Provider Name (Legal Business Name): REBECCA DANIELLE MCCOY AUD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA DANIELLE WILSON AUD.

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W. MCKINLEY AVE.
DECATUR IL
62526
US

IV. Provider business mailing address

101 W. MCKINLEY AVE.
DECATUR IL
62526
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-3682
  • Fax: 217-876-3345
Mailing address:
  • Phone: 217-876-3682
  • Fax: 217-876-3345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA . 01644
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.001324
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: