MEDICARE: MS. TABATHA ELLEN KANE OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	3411	AZ

General Provider Information

NPI Number	:	1063690089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TABATHA ELLEN KANE OTR/L

Provider Business Mailing Address
First Line	:	17017 N 12TH ST
Second Line	:	UNIT 1133
City	:	PHOENIX
State	:	AZ
Zip	:	85022-2026
Country	:	US
Telephone Number	:	480-768-7267
Fax Number	:

Provider Business Practice Location Address
First Line	:	5707 E SAINT JOHN RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-6417
Country	:	US
Telephone Number	:	602-482-3226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	01/31/2008

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