MEDICARE: MRS. TAHEERAH BAHEEJAH RAHIM-GIBSON RRT

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	103K00000X	Behavior Analyst		HI
2	227900000X	Registered Respiratory Therapist	5626	TN
3	227900000X	Registered Respiratory Therapist	RT-574	HI
4	227900000X	Registered Respiratory Therapist	RTL0005361	CO
5	247200000X	Other Technician	RBT-16-21790	HI

General Provider Information

NPI Number	:	1063845030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAHEERAH BAHEEJAH RAHIM-GIBSON RRT

Provider Business Mailing Address
First Line	:	5463 MCCULLOUGH DR APT C
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80902-1679
Country	:	US
Telephone Number	:	808-227-1808
Fax Number	:

Provider Business Practice Location Address
First Line	:	5463 MCCULLOUGH DR APT C
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80902-1679
Country	:	US
Telephone Number	:	808-227-1808
Fax Number	:

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

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	03/17/2018

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