Provider Demographics
NPI:1679394233
Name:MCDANIEL, REBECCA DANIELLE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DANIELLE
Last Name:MCDANIEL
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 1:1001 RIVER HILL DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7878
Mailing Address - Country:US
Mailing Address - Phone:262-955-4648
Mailing Address - Fax:
Practice Address - Street 1:1001 RIVER HILL DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7878
Practice Address - Country:US
Practice Address - Phone:262-955-4648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer