Provider Demographics
NPI:1487301289
Name:RETALLICK, REBEKKAH
Entity type:Individual
Prefix:
First Name:REBEKKAH
Middle Name:
Last Name:RETALLICK
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 1:1356 COOK RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9658
Mailing Address - Country:US
Mailing Address - Phone:513-507-1722
Mailing Address - Fax:
Practice Address - Street 1:1356 COOK RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9658
Practice Address - Country:US
Practice Address - Phone:513-507-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No376J00000XNursing Service Related ProvidersHomemaker