Healthcare Provider Details

I. General information

NPI: 1942897434
Provider Name (Legal Business Name): REBECCA LEMASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 PETTIT HEIGHTS RD
WELLSBURG WV
26070-2985
US

IV. Provider business mailing address

27 PETTIT HEIGHTS RD
WELLSBURG WV
26070-2985
US

V. Phone/Fax

Practice location:
  • Phone: 304-975-2396
  • Fax:
Mailing address:
  • Phone: 304-975-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: