Healthcare Provider Details

I. General information

NPI: 1538246368
Provider Name (Legal Business Name): LISA M. RABANT OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA M. RUSSICA OTR/L

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11380 PROSPERITY FARMS RD STE 109
PALM BEACH GARDENS FL
33410-3474
US

IV. Provider business mailing address

776 NW WATERLILY PL
JENSEN BEACH FL
34957-3504
US

V. Phone/Fax

Practice location:
  • Phone: 561-803-7761
  • Fax: 561-803-7762
Mailing address:
  • Phone: 772-708-6454
  • Fax: 772-692-4198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 5752
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: