Healthcare Provider Details

I. General information

NPI: 1538651732
Provider Name (Legal Business Name): LILLIAN DETTMAN-RABLEE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 CORTANA PL
BATON ROUGE LA
70815-8704
US

IV. Provider business mailing address

6173 ANTIOCH BLVD
BATON ROUGE LA
70817-4110
US

V. Phone/Fax

Practice location:
  • Phone: 985-438-1647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: