Healthcare Provider Details

I. General information

NPI: 1265203723
Provider Name (Legal Business Name): REBECCA OBOYLE BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4549 LAGOON DR
ALGER MI
48610-8511
US

IV. Provider business mailing address

4549 LAGOON DR
ALGER MI
48610-8511
US

V. Phone/Fax

Practice location:
  • Phone: 239-785-0029
  • Fax:
Mailing address:
  • Phone: 239-785-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: