=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932105491
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHY ANN RAPPORT R-EEG TECH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4100 W 15TH ST STE 208
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-5801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-985-0498
-----------------------------------------------------
Fax | 972-599-1838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3330 EARHART DR STE 206
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-4919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-991-9950
-----------------------------------------------------
Fax | 972-991-9548
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZE0500X
-----------------------------------------------------
Taxonomy Name | EEG Specialist/Technologist
-----------------------------------------------------
License Number | 2253
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------