=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629942586
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARIE RAAB OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2025
-----------------------------------------------------
Last Update Date | 10/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1125 N 13TH ST
-----------------------------------------------------
City | SHEBOYGAN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53081-3281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-803-1617
-----------------------------------------------------
Fax | 920-803-1622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2919 40TH ST APT 19E
-----------------------------------------------------
City | TWO RIVERS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54241-1344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-803-1617
-----------------------------------------------------
Fax | 920-803-1622
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 7064
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------