Provider Demographics
NPI:1306111372
Name:SEMELBAUER, REBEKAH ANN (CTRS)
Entity type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:ANN
Last Name:SEMELBAUER
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 1:1627 E BROOMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-5429
Mailing Address - Country:US
Mailing Address - Phone:989-779-9988
Mailing Address - Fax:989-779-9955
Practice Address - Street 1:1627 E BROOMFIELD ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-5429
Practice Address - Country:US
Practice Address - Phone:989-779-9988
Practice Address - Fax:989-779-9955
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI58869225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist