Provider Demographics
NPI:1447841465
Name:PARKER, REBECCA (LAC, MSOM)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 BEACH 92ND ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1426
Mailing Address - Country:US
Mailing Address - Phone:347-688-8863
Mailing Address - Fax:
Practice Address - Street 1:320 BEACH 92ND ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1426
Practice Address - Country:US
Practice Address - Phone:347-688-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3884171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty