Provider Demographics
NPI:1750119046
Name:MILLER, REBECCA A (QMHS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-2849
Mailing Address - Country:US
Mailing Address - Phone:330-797-4050
Mailing Address - Fax:
Practice Address - Street 1:57 PROSPECT LN
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:WV
Practice Address - Zip Code:26034-1919
Practice Address - Country:US
Practice Address - Phone:304-559-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator