Provider Demographics
NPI:1467050559
Name:FREDERICK, REBECCA SUE
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUE
Last Name:FREDERICK
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:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:OH
Mailing Address - Zip Code:45773-0220
Mailing Address - Country:US
Mailing Address - Phone:740-373-6180
Mailing Address - Fax:
Practice Address - Street 1:120 STERLING RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-5139
Practice Address - Country:US
Practice Address - Phone:740-373-6180
Practice Address - Fax:740-374-5841
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide