Provider Demographics
NPI:1740033190
Name:HENRY, REBECCA JANE (DSP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:HENRY
Suffix:
Gender:F
Credentials:DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44287-8009
Mailing Address - Country:US
Mailing Address - Phone:419-560-1018
Mailing Address - Fax:
Practice Address - Street 1:106 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:OH
Practice Address - Zip Code:44287-8009
Practice Address - Country:US
Practice Address - Phone:419-560-1018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care