Provider Demographics
NPI:1578630935
Name:STINE, REBECCA
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:STINE
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 1:54767 S.R. 681
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45772-9013
Mailing Address - Country:US
Mailing Address - Phone:740-378-6577
Mailing Address - Fax:
Practice Address - Street 1:54767 S.R. 681
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45772-9013
Practice Address - Country:US
Practice Address - Phone:740-378-6577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2086175374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2086175Medicaid