Provider Demographics
NPI:1730298357
Name:COATES, REBECCA M (ABC -CO)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:M
Last Name:COATES
Suffix:
Gender:F
Credentials:ABC -CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 OVERHILLS RD
Mailing Address - Street 2:
Mailing Address - City:BUNNLEVEL
Mailing Address - State:NC
Mailing Address - Zip Code:28323-8702
Mailing Address - Country:US
Mailing Address - Phone:910-494-6581
Mailing Address - Fax:910-483-2327
Practice Address - Street 1:4140 FERNCREEK DR STE 803
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2572
Practice Address - Country:US
Practice Address - Phone:910-323-9016
Practice Address - Fax:910-486-8712
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCFOM0085225000000X
NCCO03395222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795105Medicaid
NC7795188Medicaid