Healthcare Provider Details

I. General information

NPI: 1114726874
Provider Name (Legal Business Name): HALEIGH REBECCA DEEM B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 3RD AVE
MARLINTON WV
24954-1142
US

IV. Provider business mailing address

60 VALLEY CENTER RD
MONTEREY VA
24465-2525
US

V. Phone/Fax

Practice location:
  • Phone: 304-799-6865
  • Fax:
Mailing address:
  • Phone: 540-280-9263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: