=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871059105
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL MAUREEN KANE MOT, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2019
-----------------------------------------------------
Last Update Date | 02/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 N 15TH AVE
-----------------------------------------------------
City | HIAWATHA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52233-2347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-378-8583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4000 OAK VALLEY DR
-----------------------------------------------------
City | CEDAR RAPIDS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52411-7824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 094933
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------