Provider Demographics
NPI:1851949929
Name:MCKINLEY, REBEKAH MICHELE (MT)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:MICHELE
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:MICHELE
Other - Last Name:HAAKESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:108 E ARCTIC AVE
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-745-4357
Mailing Address - Fax:907-745-4606
Practice Address - Street 1:108 E ARCTIC AVE
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-745-4357
Practice Address - Fax:907-745-4606
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK146347225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK146347OtherLICENSE NUMBER