Provider Demographics
NPI:1104375302
Name:MILLER, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MILLER
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 1:132 S WATER ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62523-1332
Mailing Address - Country:US
Mailing Address - Phone:217-423-6199
Mailing Address - Fax:217-233-7028
Practice Address - Street 1:132 S WATER ST
Practice Address - Street 2:SUITE 604
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1332
Practice Address - Country:US
Practice Address - Phone:217-423-6199
Practice Address - Fax:217-233-7028
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator