MEDICARE: PRISMATIC PELVIC HEALTH, PLLC

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

General Provider Information

NPI Number	:	1346924750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRISMATIC PELVIC HEALTH, PLLC

Provider Business Mailing Address
First Line	:	33 COBBLESTONE LN
Second Line	:
City	:	LE CLAIRE
State	:	IA
Zip	:	52753-9249
Country	:	US
Telephone Number	:	563-579-5662
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 E 38TH ST STE 201B
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-1179
Country	:	US
Telephone Number	:	563-265-1154
Fax Number	:

Authorized Official
Title or Position	:	OWNER, OCCUPATIONAL THERAPIST
Name	:	RACHEL ANNE THENNES
Credential	:	MOT, OTR/L
Telephone Number	:	563-265-1154

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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