Provider Demographics
NPI:1003501537
Name:ROBERTSON, REBECCA TAYLOR
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:TAYLOR
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 FAIR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-6326
Mailing Address - Country:US
Mailing Address - Phone:330-601-5365
Mailing Address - Fax:
Practice Address - Street 1:2930 FAIR OAKS DR
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-6326
Practice Address - Country:US
Practice Address - Phone:330-601-5365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities