Provider Demographics
NPI:1124261714
Name:REID, REBEKAH LINNEA
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LINNEA
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10177 METALMARK LN
Mailing Address - Street 2:UNIT #4
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-5685
Mailing Address - Country:US
Mailing Address - Phone:815-978-4982
Mailing Address - Fax:
Practice Address - Street 1:1752 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4280
Practice Address - Country:US
Practice Address - Phone:815-654-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-12
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist