Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 60819142 | WA |
NPI | 1275022204 |
---|---|
Provider Name | Emilee Larissa Rath |
First Address | Bismarck, ND 58504-7061 |
Second Address | Bismarck, ND 58504-7061 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2018 |
Last Update Date | 04/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
501982477 | TRICARE (01) | ND |