Provider Demographics
NPI:1265203723
Name:OBOYLE, REBECCA (BA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:OBOYLE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4549 LAGOON DR
Mailing Address - Street 2:
Mailing Address - City:ALGER
Mailing Address - State:MI
Mailing Address - Zip Code:48610-8511
Mailing Address - Country:US
Mailing Address - Phone:239-785-0029
Mailing Address - Fax:
Practice Address - Street 1:4549 LAGOON DR
Practice Address - Street 2:
Practice Address - City:ALGER
Practice Address - State:MI
Practice Address - Zip Code:48610-8511
Practice Address - Country:US
Practice Address - Phone:239-785-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker