Provider Demographics
NPI:1982916029
Name:ABBOTT, REBECCA B (CAC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:B
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11203 N BUNTROCK AVE
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1857
Mailing Address - Country:US
Mailing Address - Phone:262-512-1661
Mailing Address - Fax:262-512-1663
Practice Address - Street 1:11203 N BUNTROCK AVE
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-1857
Practice Address - Country:US
Practice Address - Phone:262-512-1661
Practice Address - Fax:262-512-1663
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI478055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist