Provider Demographics
NPI:1780168591
Name:WINDMILLER, REBEKAH
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:WINDMILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:WINDMILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAT
Mailing Address - Street 1:120 PIONEER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-1611
Mailing Address - Country:US
Mailing Address - Phone:646-522-1550
Mailing Address - Fax:
Practice Address - Street 1:120 PIONEER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-1611
Practice Address - Country:US
Practice Address - Phone:646-522-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1191-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist