Provider Demographics
NPI:1407458326
Name:KIRBY, REBBECCA
Entity Type:Individual
Prefix:
First Name:REBBECCA
Middle Name:
Last Name:KIRBY
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 1:6001 COUNTY ROAD 191
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:OH
Mailing Address - Zip Code:43334
Mailing Address - Country:US
Mailing Address - Phone:740-501-8080
Mailing Address - Fax:
Practice Address - Street 1:6001 COUNTY ROAD 191
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:OH
Practice Address - Zip Code:43334-4333
Practice Address - Country:US
Practice Address - Phone:740-501-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care