MEDICARE: LISA M. RABANT OTR/L, CHT

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	225XH1200X	Hand Occupational Therapist	OT 5752	FL

General Provider Information

NPI Number	:	1538246368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M. RABANT OTR/L, CHT

Provider Business Mailing Address
First Line	:	776 NW WATERLILY PL
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3504
Country	:	US
Telephone Number	:	772-708-6454
Fax Number	:	772-692-4198

Provider Business Practice Location Address
First Line	:	11380 PROSPERITY FARMS RD
Second Line	:	STE 109
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3474
Country	:	US
Telephone Number	:	561-803-7761
Fax Number	:	561-803-7762

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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