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NPI Code Detail

MEDICARE: MS. TABATHA ELLEN KANE OTR/L

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
1225X00000XOccupational Therapist3411AZ

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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Directions to “ MS. TABATHA ELLEN KANE OTR/L” Practice Location

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