Provider Demographics
NPI:1992364996
Name:BRACKEN-TAYLOR, REBECCA LOUISE (DO)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LOUISE
Last Name:BRACKEN-TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LOUISE
Other - Last Name:BRACKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:14601 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4205
Mailing Address - Country:US
Mailing Address - Phone:216-237-5500
Mailing Address - Fax:
Practice Address - Street 1:200 MULLINS DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-3983
Practice Address - Country:US
Practice Address - Phone:541-259-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2023-09-01
Deactivation Date:2023-05-30
Deactivation Code:
Reactivation Date:2023-07-12
Provider Licenses
StateLicense IDTaxonomies
OH58.033837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine