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General NPI Number Information
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NPI Number | 1053984658
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Entity Type | Individual
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Provider Name | MISS REBECCA CAITLYN DAILEY
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Gender | Female
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 404 N MAIN ST
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City | OSHKOSH
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State | WI
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Zip | 54901-4957
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Country | US
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Telephone | 920-420-8778
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Fax |
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Provider Business Mailing Address
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Address Line | 5048 GINNOW RD
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City | OMRO
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State | WI
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Zip | 54963-9352
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Country | US
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Telephone | 920-420-8778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZA2600X
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Taxonomy Name | Medical Art Specialist/Technologist
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License Number | 4368-403
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License Number State | WI
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