Provider Demographics
NPI:1225048499
Name:RATHJEN, REBECCA S (OT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:S
Last Name:RATHJEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 INDIANHEAD DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-6429
Mailing Address - Country:US
Mailing Address - Phone:308-385-4768
Mailing Address - Fax:308-381-3646
Practice Address - Street 1:4135 INDIANHEAD DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-6429
Practice Address - Country:US
Practice Address - Phone:308-385-4768
Practice Address - Fax:308-381-3646
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE745174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278410Medicare ID - Type Unspecified