MEDICARE: EMILEE LARISSA RATH 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	225XP0019X	Physical Rehabilitation Occupational Therapist	60819142	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	501982477	OTHER	ND	TRICARE

General Provider Information

NPI Number	:	1275022204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILEE LARISSA RATH OTR/L

Provider Business Mailing Address
First Line	:	1815 S RENO DR
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-7061
Country	:	US
Telephone Number	:	701-202-7215
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 S RENO DR
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-7061
Country	:	US
Telephone Number	:	701-202-7215
Fax Number	:

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

Provider Enumeration Date	:	05/04/2018
Last Update Date	:	05/04/2018

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