Healthcare Provider Details

I. General information

NPI: 1770046393
Provider Name (Legal Business Name): REBECCA RANCOURT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SILVER ST
WATERVILLE ME
04901-5927
US

IV. Provider business mailing address

41 LABRADOR LN
FREEPORT ME
04032-6630
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-0320
  • Fax:
Mailing address:
  • Phone: 207-577-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: