Provider Demographics
NPI:1932490067
Name:STIGEN, REBECCA ANN (ATC/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:STIGEN
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-1198
Mailing Address - Country:US
Mailing Address - Phone:636-287-9498
Mailing Address - Fax:
Practice Address - Street 1:3616 PIONEER DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-1198
Practice Address - Country:US
Practice Address - Phone:636-287-9498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-23
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1097672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer