Provider Demographics
NPI:1275022204
Name:RATH, EMILEE LARISSA (OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILEE
Middle Name:LARISSA
Last Name:RATH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 S RENO DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7061
Mailing Address - Country:US
Mailing Address - Phone:701-202-7215
Mailing Address - Fax:
Practice Address - Street 1:1815 S RENO DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-7061
Practice Address - Country:US
Practice Address - Phone:701-202-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60819142225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND501982477OtherTRICARE