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General NPI Number Information
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NPI Number | 1467050559
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Entity Type | Individual
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Provider Name | MRS. REBECCA SUE FREDERICK
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Gender | Female
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 120 STERLING RD
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City | MARIETTA
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State | OH
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Zip | 45750-5139
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Country | US
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Telephone | 740-373-6180
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Fax | 740-374-5841
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Provider Business Mailing Address
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Address Line | PO BOX 220
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City | RENO
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State | OH
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Zip | 45773-0220
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Country | US
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Telephone | 740-373-6180
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State | OH
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