Provider Demographics
NPI:1184886343
Name:PHILLIPS, REBECCA LEE (CTRS)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:LEE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 ELGIN AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2333
Mailing Address - Country:US
Mailing Address - Phone:708-202-4670
Mailing Address - Fax:
Practice Address - Street 1:5TH AND ROOSEVELT RD
Practice Address - Street 2:11K
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist