MEDICARE: KATHY ANN RAPPORT R-EEG TECH

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	246ZE0500X	EEG Specialist/Technologist	2253	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2253	OTHER	TX	R-EEG-T
2	278	OTHER	TX	CNIH

General Provider Information

NPI Number	:	1932105491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY ANN RAPPORT R-EEG TECH

Provider Business Mailing Address
First Line	:	3330 EARHART DR
Second Line	:	STE 206
City	:	CARROLLTON
State	:	TX
Zip	:	75006-4919
Country	:	US
Telephone Number	:	972-991-9950
Fax Number	:	972-991-9548

Provider Business Practice Location Address
First Line	:	4100 W 15TH ST
Second Line	:	STE 208
City	:	PLANO
State	:	TX
Zip	:	75093-5801
Country	:	US
Telephone Number	:	972-985-0498
Fax Number	:	972-599-1838

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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Directions to “ KATHY ANN RAPPORT R-EEG TECH” Practice Location

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