Provider Demographics
NPI:1275232399
Name:HICKEY, REBECCA TIMMERMAN (MA)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:TIMMERMAN
Last Name:HICKEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 SW WESTER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-1849
Mailing Address - Country:US
Mailing Address - Phone:386-438-4130
Mailing Address - Fax:
Practice Address - Street 1:1924 SW WESTER DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-1849
Practice Address - Country:US
Practice Address - Phone:386-438-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46599225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty