MEDICARE: MRS. KIMBERLY WHITE RASOR OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT9147	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447449251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY WHITE RASOR OTR/L

Provider Business Mailing Address
First Line	:	4702 VETERAN TERR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-8550
Country	:	US
Telephone Number	:	561-254-4568
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 S CONGRESS AVE
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-7670
Country	:	US
Telephone Number	:	561-254-4568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	12/10/2020

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